Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

PRIVATE BUSINESS

LLANELLI BOROUGH COUNCIL (DAFEN ESTUARY) BILL [Lords]

Read a Second time, and committed.

Oral Answers to Questions — HEALTH

Health Plans

Mr. Carrington: To ask the Secretary of State for Health if he will make a statement on the progress of health plans to meet health needs in regional health authorities.

The Secretary of State for Health (Mr. William Waldegrave): Every regional health authority has submitted to my Department a plan for 1991–92 putting forward its key objectives and setting out levels of activity to be purchased to meet the health needs of its population. Regions are also developing strategies to improve health based on health needs identified in director of public health reports, which are published annually.

Mr. Carrington: My right hon. Friend will be aware that inner London is facing considerable problems in adjusting to the new structures of the national health service because of the high cost of London teaching hospitals. Will he reassure my constituents that the availability and quality of their health care will be assured under the new contracts?

Mr. Waldegrave: It is not fair to say that the problems facing London derive from the reforms. Everyone concerned with the national health service knows that there have been long-postponed issues to do with the division of NHS resources between London and the rest of the country, to which the reforms are indeed drawing attention. The regions and districts, together with the Department of Education and Science and those who have responsibility with us for teaching, must steer London carefully through the reform process.

Mr. Salmond: If the Minister is so confident that the planning and changes that he is introducing into the NHS have support, why are the Government so intent on appointing so many card-carrying members of the Tory party to positions of responsibility in the NHS? Are the members whom he is appointing a greater or smaller

proportion than the extraordinary number of Tories who have been appointed to positions of responsibility in Scotland?

Mr. Waldegrave: I am not particularly interested in the party affiliations of those whom we appoint. We have appointed a good many people from other parties, although not, the hon. Gentleman will understand, within my responsibility, from his party.

Dame Elaine Kellett-Bowman: Is my right hon. Friend aware—I gather from his answer to my hon. Friend the Member for Fulham (Mr. Carrington) that he is—that in my part of the world, in Lancaster and the north-west, we are glad that resources are at last being channelled to our area? We run our affairs prudently and are not short of staff or laying off staff.

Mr. Waldegrave: My hon. Friend is right, and I do not think that, fundamentally, there is any division between the two sides of the House on the issue. There needs to be a fairer distribution of health resources across the country. The reforms are clearly resulting in our making decisions in London that have been long deferred by both parties. We must do that, but we must do it skilfully.

Mr. Campbell-Savours: Why will not the Secretary of State publish all the business plans of all the trusts and all the documents that have been submitted by those organisations to his Department? The public should know the truth now. The debate in recent weeks has been about that, so let us see the documents and let the public know the truth.

Mr. Waldegrave: The hon. Gentleman is wrong. The debate has not been quite about that. There are a variety of management documents for directly managed hospitals and trusts that have not been prepared for publication. Many trusts are perfectly prepared to publish the documents, and why should they not do so if they choose? But it would be unfair on them to change the goalposts half way through and ask them to publish internal management documents that were not prepared for publication.

Child Abuse

Mr. Day: To ask the Secretary of State for Health what assessment he has made of the impact of the Children Act 1989 on the handling of child abuse cases.

The Minister for Health (Mrs. Virginia Bottomley): The Children Act 1989 will have a major impact when it is introduced five months from now, in October. It provides a proper framework to safeguard the child as well as the parents and will promote firm action to protect the child when necessary.

Mr. Day: Does my hon. Friend agree that the Children Act recognises fully the importance of the role of parents?

Mrs. Bottomley: The Children Act redresses the imbalance in terms of recognising the on-going responsibility of parents. Two new orders are the emergency protection order, which enables parents to return to court after 72 hours to put their case, and the child assessment order, which means that the child can be assessed without removing parental rights.

Mr. Hinchliffe: Is the Minister aware that there appears to be a deliberate campaign of misinformation in certain sections of the press about the role of social workers in child abuse cases? Will he take the opportunity of the implementation of the Act in October to launch a public information campaign, setting out the rights and duties of parents under the legislation and also the rights, responsibilities and duties of local authorities and the social workers whom they employ?

Mrs. Bottomley: I certainly endorse the hon. Gentleman's point. However, the decisions that social workers must make are enormously complex. If social workers remove a child needlessly, they are castigated; but if they do not remove a child and it is abused, they are also castigated. Sometimes it appears that there is a ritual abuse of social workers.
In implementing the Act we are determined to clarify the rights of parents. The Family Rights Group, for example, has been working on a handbook for that purpose. We are also determined to clarify the role and responsibility of social workers. If they can remember that their prime duty is the welfare of the child and the need to have clear evidence, they may be able to avoid some of the pitfalls that have occurred in recent cases.

Miss Emma Nicholson: Will my hon. Friend consider, when looking at the aftermath of child sex abuse cases in the past two years, giving child psychotherapists a primary responsibility for identifying whether a child should be taken into care? I ask that because, as my hon. Friend knows, the modern social worker is a generic animal and does not have the specific child care knowledge that the old-style children's officer used to have.

Mrs. Bottomley: Skilled and professional workers should also know the limit of their knowledge and there are clearly times when they need to seek further expertise and advice. Our major implementation programme for the Children Act is unprecedented in child care. I recently announced a further package of initiatives, amounting to £1 million, to deal with various aspects of child abuse. One of those involves the treatment of victims of child abuse. The aspect that my hon. Friend indentifies is part and parcel of the matters on which we hope to make further progress.

Mr. Rooker: I think that the Minister appreciates that there is a good deal more common ground on that issue than on many that come before the House. What action is being taken to remedy the acute shortage of qualified social workers to implement the most significant piece of child care legislation for the past 100 years? If 50 per cent. of local authorities are to implement the Act on the financial basis of cuts or no growth, how will they meet the strict new timetables laid down by the courts for the detailed and rigid assessments required, given that shortage? How will the social service departments avoid families becoming child abuse statistics if they do not have the resources to operate what must be the ultimate user-friendly service?

Mrs. Bottomley: I endorse the hon. Gentleman's point about the spirit of co-operation that underlies the implementation of the Act. Because of the resource implications, this year local authorities, in their personal social services standard spending assessments, have seen an increase of 23·5 per cent., which is the biggest increase

in money going into social services for 15 years. Moreover, there has been a 40 per cent. increase for social worker training, amounting to £50 million.
I recently hosted a meeting with local authority representatives, social services inspectors and directors of social services and talked about how we could secure the commitment of long-term social workers to the service. We considered manpower, training and deployment issues. Many local authorities could do better in deploying their existing work force. We have more social workers and more of them are well qualified, and we must use them as effectively as we can in implementing this important Act.

Mr. Holt: My hon. Friend will know that the Children Act arose as a direct result of the Cleveland child sex abuse scandal. How does she react to the fact that my constituents who were caught up in that scandal are still, seven months later, waiting for compensation? It should have been paid to them, but is being held up because of the solicitor acting on behalf of the local authority and the doctors involved, who caused the scandal in the first place.

Mrs. Bottomley: My hon. Friend played a major role in drawing attention to the situation in Cleveland and championing the cause of his constituents. I am happy to report that when the social services inspectorate went back to Cleveland relatively recently, it was most impressed by the way in which lessons had been learned and the new procedures implemented. I have no information available on my hon. Friend's specific worry, but I shall take up the matter on his behalf.

Mental Health Foundation (Mid-Staffordshire)

Mrs. Heal: To ask the Secretary of State for Health if he will make a statement on the future of the Mental Health Foundation of Mid Staffordshire national health service trust.

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell): We have every confidence that this trust will continue to raise the quality of care available to its NHS patients.

Mrs. Heal: Does the Minister agree that the only way to guarantee the highest quality of standards and services for people with mental illness is to ensure that the mental health services stay as an integral part of health and social care? We must not allow them to opt out, operate separately and sell their services to general practitioners and hospitals, thus providing a fragmented service that will allow patients to fall through the net.

Mr. Dorrell: I entirely agree with the hon. Lady that mental health services must be an integrated part of the national health service, which is where they remain when they are run by NHS trusts. I hoped that the hon. Lady would use the opportunity of her question this afternoon to welcome the fact that the trust has already employed 20 additional staff in the mental health services of Staffordshire since 1 April and is committed to a further 20 staff before the end of this year. I hoped that she might also welcome the commitment to quality of service by the trust which is shown by the introduction of patient questionnaires, regular surveys of long-stay patients and a medical audit, the setting of standards and by the facts that 90 per cent. of all staff have attended training on quality


and public meetings are being held every two months. I should have thought that the hon. Lady would welcome at least some of those facts.

Guy's and Lewisham NHS Trust

Ms. Ruddock: To ask the Secretary of State for Health if he will make a statement on the future of the Guy's and Lewisham national health service trust.

Mr. Waldegrave: The long-term future of the Guy's and Lewisham national health service trust will ultimately be determined by the willingness of districts and GP's to send patients there.
I am confident that the managers and clinicians at Guy's and Lewisham will continue to ensure that high-quality, cost-effective patient care is provided to meet the needs both of local people and of patients from further afield.

Ms. Ruddock: Will the Secretary of State guarantee that no two-tier service will develop in Lewisham? Is he aware that the two fund-holding general practitioners from Bromley have applied to the trust for a contract that not only asks for accelerated waiting times but demands that all their patients are seen by locum consultants and senior registrars? Will he instruct the trust not to accept that contract, or does he believe that my constituents deserve a second-rate service?

Mr. Waldegrave: I should have thought that the hon. Lady might welcome the new and better services that many of her constituents are receiving and would turn to the districts and say that they should match that performance in their contracts. It is a pity that she did not mention, for example, the new children's unit that is to be opened at Lewisham hospital this week to replace the 119-year-old unit at Sydenham hospital—perhaps she will be at its opening.

Mr. Hayes: Does my right hon. Friend agree that it is dangerous, cynical, electioneering nonsense to talk about a two-tier system? Will my right hon. Friend make it 100 per cent. and unequivocally clear that the health service trusts are not opting out of the health service and are beholden not to big business, property developers or shareholders but to the best possible care of patients?

Mr. Waldegrave: As my right hon. Friend the Prime Minister said, if they are opting out of anything, it is bureaucracy. As every doctor must have been trained in an independent, board-run hospital, it strikes me as ironic that so many of them seem to find the idea surprising.

Ms. Harman: Will the Secretary of State answer the question of my right hon. Friend the Member for Lewisham, Deptford (Ms. Ruddock)? Will there be queue-jumping at Guy's and Lewisham, which will mean that, instead of patients being treated according to clinical need, some patients will have to wait longer and be treated by more junior members of staff because a minority will be able to jump the queue? Is that the system that we shall see at Guy's and Lewisham?

Mr. Waldegrave: The hon. Lady is confused. It is for Guy's and Lewisham, as a hospital trust, to set its proper priorities for clinical care. Those who are seeking better

treatment for patients, whether they are districts or GP fund holders, are doing their best for their patients and should be encouraged to do so.

Severely Disabled People

Mr. Hannam: To ask the Secretary of State for Health what arrangements will ensure severely disabled people have control over their own personal assistance arrangements under the community care proposals.

Mrs. Virginia Bottomley: Our guidance to local authorities emphasises that service users, including severely disabled people and their carers, should be involved as closely as possible in decisions about what services should be provided to them individually. Section 46 of the National Health Service and Community Care Act 1990 also requires that local authorities consult representatives of users and carers in preparing their community care plans.

Mr. Hannam: Does my hon. Friend accept that when local authorities cannot provide the personal assistance that severely disabled people need if they are to live independent lives in the community, the present practice is that those local authorities can make cash payments to allow disabled people to buy in those services—and that that should be allowed to continue? Does she recall that she and other Ministers and the Audit Commission supported that idea in principle, and will she look for a way of putting it on a statutory basis?

Mrs. Bottomley: As my hon. Friend is well aware, it has not been possible to find a way to break the long-standing tradition in which local authority social service departments provide services and social security departments provide financial resources. As my hon. Friend knows, I am most sympathetic to the approach that says that those who are severely disabled should feel as far as possible in control of their destiny and of the care that they receive. In our practice guidance we shall emphasise that as strongly as we can.

Mr. Wigley: Does the hon. Lady accept that for such disabled people to have a real choice they need consultation and representation of the sort embodied in the Disabled Persons (Services, Consultation and Representation) Act 1986? The section to which she referred does not go anything like as far as that Act in ensuring that disabled people's voices are adequately heard so as to ensure valid choice for them.

Mrs. Bottomley: I do not accept that. I refer the hon. Gentleman to the debate initiated by the hon. Member for Monklands, West (Mr. Clarke) in which many of these issues were discussed. Since the passage of the Disabled Persons (Services, Consultation and Representation) Act, care for and understanding of disabled people have moved forward at a great pace and the philosophy of "Does he take sugar?" is, I hope, a thing of the past. The National Health Service and Community Care Act overtakes the Disabled Persons (Services, Consultation and Representation) Act; but we shall of course keep the matter under review once the formal requirements to consult the users and the carers on plans and assessments have been implemented. The local authority associations have been given a clear commitment, as have others


concerned with the disabled, that we shall continue to review the matter once community care is fully implemented.

Mr. Alfred Morris: Is the hon. Lady aware that the fundamental issue here is one of human dignity and independent living for disabled people? How does she respond to the letter in The Times from her hon. Friend the Member for Mid-Kent (Mr. Rowe), published last Thursday, about the need to end the legal impasse? Is she aware of the widely held view among disabled people, as reported by the Spinal Injuries Association, that the Government's attitude on this issue is "patronising and ill conceived"? Will she act now to give them both choice and the fullest possible control over their own lives?

Mrs. Bottomley: I very much hope that all the energy and commitment of the many organisations concerned with disabled people will be transformed into working with local authorities and their community care plans. Local authorities must have those plans drawn up within the year. They have to consult users and carers in that work, and I believe that the special protected position of disabled people under the Act should be broadened to ensure that community care moves forward as fast as possible.

Waiting Lists

Mr. David Marshall: To ask the Secretary of State for Health what research has been conducted on the relationship between the length of national health service waiting lists and the availability of private practice.

Mr. Patchett: To ask the Secretary of State for Health if he will initiate a study into the effects of the availability of private practice on national health service waiting lists.

Mr. Waldegrave: We have not conducted, nor do we plan to conduct, any research into the relationship between private practice and national health service waiting lists. However, we are determined to tackle long waiting times for NHS treatment. The NHS management executive is agreeing tough targets with all 14 regional health authorities for substantial reductions, by March 1992, in the numbers waiting over one year for treatment.

Mr. Marshall: Is not it a disgrace that, three months after John Yates, the Government's former waiting list expert, drew attention to the fact that private practice by national health service consultants may be leading to longer waiting lists for NHS patients, the Government have done nothing about it? The Secretary of State's reply is just not good enough. Will he assure the House that an immediate investigation will be carried out into this matter, or does he simply intend to expand his party's two-tier health service, which means priority for private patients and longer waiting lists for national health service patients?

Mr. Waldegrave: I do not think that the hon. Gentleman has exactly and correctly reported Mr. Yates's views. If the hon. Gentleman will produce evidence to back what he says, I shall look into it. The hon. Gentleman presents yet a further argument in favour of national health service trusts. Those trusts will hold the contracts

for their consultants, and it will be open to them to negotiate with their consultants if they wish to see them carrying out more national health service work.

Mr. Patchett: Given the evidence of Mr. John Yates to the Select Committee, does not the Minister recognise the need for a study of this matter and the possible dire consequences to the health service if it is ignored?

Mr. Waldegrave: I think that my previous reply answers the hon. Gentleman's question. If the baying of Opposition Members over the issue of independent practice by doctors were drawn to the attention of the British Medical Association, it might dampen the association's enthusiasm for anything that might lead to a Labour Government.

Mr. Michael Morris: Is my right hon. Friend aware that whenever the Public Accounts Committee has looked at any alleged negative relationship it has found none? Will my right hon. Friend ensure that the whole issue of waiting lists is simplifed so that health authorities who remove people from the waiting lists are paid after they have performed the required service?

Mr. Waldegrave: I confirm that my hon. Friend is right. There has never been any evidence to show what has been alleged. There is unfair reporting of the matter. One of the newspapers that supports the Opposition, the Daily Mirror, reports another of Mr. Yates's ideas, which is to give incentives to doctors who do well in reducing waiting lists. However, the Daily Mirror reports that in most unfair terms as being a dreadful thing to do. I am not sure whether the Labour party is in favour of Mr. Yates or against him.

Mrs. Peacock: Will my right hon. Friend not be drawn along lines that confuse the issue but confirm that the national health service is what it says it is, what it has always been and what it always will be—a service that is available when needed and free at the point of need?

Mr. Waldegrave: I have no difficulty in fully endorsing that. In response to these questions, I re-endorse an element of the policy of the national health service's founding Minister, Mr. Aneurin Bevan, who made a historic compromise with consultants when he allowed them independent practice in NHS hospitals.

Mrs. Dunwoody: Is the Secretary of State aware that the BMA does not represent consultants? If he wants to know what consultants think, he should talk to their representative groups. Would he ask them to explain why, over a recent holiday weekend, the trust in my area simply stopped taking in patients because it did not have a senior registrar available to do the work?

Mr. Waldegrave: I think that Mr. John Chawner would be confused to be described as not representing consultants. He regards that as his job and he certainly represented them when he saw me a few days ago. I am willing to admit that, in the few weeks in which they have been in existence, the trusts have not solved all the problems of the national health service. There are still problems, but I assure the hon. Lady that the management delivered by her NHS trust will be much better than the traditional management, which created these problems in the first place.

NHS Funding

Mr. Robert B. Jones: To ask the Secretary of State for Health what has been the real growth in capital spending in the national health service since 1979.

Mr. Dorrell: Gross capital expenditure in the national health service in England has grown by 62 per cent. in real terms since 1978–79.

Mr. Jones: I am grateful to my hon. Friend for that answer. Will he confirm that it includes more than £40 million-worth of new capital investment in the North Hertfordshire district health authority area? Those projects are well appreciated by those who live in the areas concerned, especially as the projects were cancelled by the Labour Government.

Mr. Dorrell: My hon. Friend is right in his figures and in drawing a favourable comparison between our record and that of our predecessors. In the past 12 years, capital investment has increased by 62 per cent. in real terms while under the Labour Government it decreased by 16 per cent. in five years.

Mr. Bermingham: Does the Minister agree, that as he knows all too well, in the St. Helen's and Knowsley hospitals area investigations show that capital and other funding has always been undercut? Now that we have hospital trusts—both hospitals have opted out—are we to understand that the hospitals will get no more capital and that there is no hope of our ever having the capital that we should have had over the past 15 years?

Mr. Dorrell: The hon. Gentleman has not quite caught up with the Leader of the Opposition. The funding argument is over. The Labour party is clearly on the record as saying that an incoming Labour Government would have no new money for the national health service. The question that the hon. Gentleman asked me is one that he should put equally to the Opposition Front Bench.

Sir Anthony Grant: Does my hon. Friend agree that while, we welcome the additional resources that have been made available in the eastern region, in formulating hospital policy big is not necessarily beautiful? I cite, for example, the unsatisfactory proposal to move the world famous Papworth hospital into the already over-large Addenbrooke's hospital.

Mr. Dorrell: I entirely agree with my hon. Friend that big is not necessarily beautiful. In designing future NHS provision, it is important to ensure that it meets the identified needs of patients. That is the priority that we have established through the establishment of the purchaser-provider split. We have ensured that it is the principal responsibility of the new health authorities.

NHS and Community Care Act

Mrs. Fyfe: To ask the Secretary of State for Health when he last met representatives of local authorities to discuss the implementation of the National Health Service and Community Care Act 1990.

Mrs. Virginia Bottomley: Ministers regularly meet representatives of local authority associations to discuss a range of matters, including community care implementation. They last met them on 16 April.

Mrs. Fyfe: Does the Minister recall telling the Leonard Cheshire Foundation conference recently that caring and costing are related? If so, what has she told local authorities about community care? More than half the local authorities are having to make cuts in their community service provision and in their grants to voluntary bodies. Those cuts are necessary if authorities are to fulfil their statutory obligation to implement their part of the care in the community policy.

Mrs. Bottomley: I was honoured to speak at the annual general meeting of the Leonard Cheshire Foundation, which provided an excellent example of care in the community. Perhaps those who were wasting money on the £1·5 million National and Local Government Officers Association's advertisement last week should have paid attention to it. In talking with local authority associations, we are discussing the 23·5 per cent. increase for social services this year, which is in part the result of phase 1 of the community care programme. We have taken the unprecedented step of providing specific grants for voluntary organisations which provide drug and alcohol support as well as introducing a specific grant for the mentally ill. In short, the meetings with local authority associations integrate caring and costing. We make it clear that the Government will support community care and we look to local authorities diligently to implement the policy.

Mr. Robin Cook: Has the Minister grasped the sharp increase in charges that social services authorities are having to make for disabled and elderly people? Is he aware that the average rise in charges for home helps is one third, which is four times the rate of inflation? How many elderly people does the Minister know whose benefit has increased by a third in the past year? Does it not make a mockery of care in the community if elderly and disabled people have to pay for the care that they need?

Mrs. Bottomley: What is clear is that local authorities need to think through their charging policies. As hon. Members will know, Derbyshire, for instance, provides one in three of its elderly residents with a home help, and charges nothing. There has been a dramatic expansion in community services, with an increase of 30 per cent. in the number of day centres for the elderly, an increase of 25 per cent. in the meals on wheels service and a 27 per cent. increase in the number of home helps.
As local authorities implement the community care policies, it is essential that they manage their resources effectively and well. The spending of social services departments has risen by 52 per cent. in the past 11 years. We are already clearly identifying the cost of implementing community care and, in turning that policy into practice, local authorities must ensure that they achieve good value for money.

Mr. Kennedy: When the Minister comes out with statements like that about the reality of community care, she seems to pay no attention to the findings of the Radio 4 programme "You and Yours", on which she was interviewed last week. The programme carried out an in-depth analysis of the subject, across the whole country. Does the Minister accept that—according to the clear evidence that emerged from that process, and the direct feedback from those who were involved and consulted, community care is in a catastrophic state because of underfunding and because of the delays to which it has


been subjected? Anyone who has talked to those in the local social services departments will inform hon. Members on both sides of the House of that.

Mrs. Bottomley: As I hope that all hon. Members will agree, the key issue is that the challenge of caring in the community affects all our constituents as demographic factors change and expectations rise. We must harness the good will of the community to meet those care needs, to provide carers with practical support and to ensure that our provision is truly user-led rather than producer-driven.
Local authorities, health authorities, voluntary organisations and the private sector certainly need the two years that it will take them to phase in community care. We have already made a start with the mental illness and drug and alcohol treatment facilities, the training and the complaints procedure. We look to local authorities to work with us in a constructive partnership to implement what is a popular and very important policy.

NHS Doctors

Mr. Barry Field: To ask the Secretary of State for Health how many doctors were working in the national health service in 1979 and in 1990.

Mr. Waldegrave: The number of doctors in the national health service in England has risen from 61,554 in 1979 to 72,446 in 1989.

Mr. Field: I thank my right hon. Friend for that reply. Does he agree that it represents a record of achievement, under a Conservative Government, of which we should be proud? More doctors are spending more time with their patients, and there are fewer of those patients.
Will my right hon. Friend reassure the House, however, that the taxpayer's pocket is not being misused to allow a tiny minority of doctors to practice politics rather than patient care?

Mr. Waldegrave: My hon. Friend is right to pay tribute to the Government for the major increase in the number of medical and clinical personnel in the NHS. That is reflected in the many more treatments that have been afforded to our people.
On the Isle of Wight, my hon. Friend may have come across one general practitioner who seems able to spend a great deal of time outside his surgery.

Mr. Madden: Does the Secretary of State accept that members of the British Medical Association in Bradford voted by a large majority against the establishment of the Bradford health trust? Does he agree that the cuts announced so far—a £7 million cut and 300 redundancies—have done nothing to allay those doctors' anxiety?
Will the right hon. Gentleman now agree to open the books? Will he allow the publication of the business plan and the Coopers and Lybrand Deloitte financial report, and will he allow the Select Committee on Health, which is to interview the chief executive and the chairman next week, to question both officials fully and thoroughly about evidence that is published and available to them?

Mr. Waldegrave: The Select Committee needs no encouragement from me to carry out its questioning, and I am sure that it will do so excellently.
The hon. Gentleman is wrong to say that there will be 300 redundancies in the trust. There is no question of that. The underlying problems of that hospital, which go back many years, are now being tackled by much better management, and the hon. Gentleman will soon see a hospital with a secure and successful future.

Mr. Dykes: Does my right hon. Friend agree that, under the old arrangements, a significant and regrettable minority of GPs treated their patients with less than the full care that we would expect and that the current much more positive response from GPs is already being manifested under our new arrangements?

Mr. Waldegrave: I think that they were always a very small minority. The new GP contract, which is delivering major improvements in services to all our patients in this country, shows that GPs are providing ever better service. It is characteristic of the Labour party, I am afraid, to oppose the new GP contract.

NHS Trusts

Ms. Armstrong: To ask the Secretary of State for Health what advice he is giving the Northern region health authority in respect of future applications for national health service trust status.

Mr. Dorrell: We have made it clear that trust status is our management model of choice throughout the NHS.

Ms. Armstrong: Is the Minister aware that there is deep resentment and anxiety in the Northern region about the Government's pushing hospitals to go for opted-out status? I am particularly concerned about the financial viability of the north-west Durham health application. Will he guarantee today that the business plans in connection with that application and others will be published so that people who now feel anxiety will be able to see for themselves precisely what the future offers?

Mr. Dorrell: My right hon. Friend the Secretary of State has already dealt with the question of the publication of business plans. I remind the hon. Lady that NHS trusts have an obligation to publish reports to the local public. That obligation is entirely new—it was never in the traditional model of management of the national health service.

Mr. Devlin: Is not the situation in inner London rather different from that in the Northern region? In inner London there are 82 consultants and 420 beds per 100,000 population, whereas in the Northern region there are only 26 consultants and 260 beds per 100,000. Does that not show that in the past 10 years the Government, through the 39 major capital schemes in our region, have shown an unequalled commitment to the improvement of the health service in the Northern region, which is now being demonstrated by the number of local hospitals that wish to take on trust status so as better to serve their local population?

Mr. Dorrell: My hon. Friend is absolutely right to draw attention to the difference between experience in London and that in the Northern region. He may be interested to know that experience so far of Northern region trusts is that the three existing trusts, in the six weeks that they have been in existence, have already created 11 new consultant


posts. One might have hoped that the hon. Member for Durham, North-West (Ms. Armstrong) would welcome that.

Mr. Foulkes: To ask the Secretary of State for Health if he will gather information on the experience of national health service trusts, with particular reference to staffing and finance.

Mrs. Virginia Bottomley: Trusts are required to publish annual accounts and reports about their work. They are also required to submit business plans to the Department. They are free, however, to determine the number of staff they employ and to set the terms and conditions they offer them. We are confident that trusts will deliver real benefits to their local communities.

Mr. Foulkes: Would the hon. Lady care to estimate how long it will be before she receives the first application from the directors of an NHS trust to go completely private? Will she give an absolute assurance that if she is still the Minister and the present Government are still in power they will do absolutely nothing to enable NHS trusts to become completely private hospitals?

Mrs. Bottomley: I find it positively incredible that a member of a party that cut resources for the health service in real terms, cut the capital building programme and cut nurses' pay, should have the outrageous cheek to ask a question of that sort. I can give the hon. Gentleman a clear assurance that NHS trusts are intended to ensure better management of the national health service for better patient care. That is what we have invested in the health service for, that is why we have increased the number of staff, that is why we have improved the training, and that is why we are now improving the management structure—to provide better patient care. There is no hidden agenda; there is no intention whatsoever that NHS trusts should do anything other than remain part of the national health service.

Mr. Sims: Is it not a fact that the national health service trusts came into operation just six weeks ago and that, while of course it would be perfectly valid in a year or two to evaluate how they are working out in practice, the present campaign by the Labour party against trusts, when they have barely started, is completely phoney?

Mrs. Bottomley: As my hon. Friend will know, the Opposition, having so singularly failed to deliver when they were in control of the health service, now indulge in a policy of scaring rather than caring. We have seen it all before. We had it with general practitioner contracts and with the indicative list, and now we have it with trusts. We on the Conservative Benches know that we are right to be carrying forward between management plans for the health service.

Mr. Robin Cook: Will the Minister confirm that she has again appointed Coopers and Lybrand Deloitte to study the information that she is receiving from the second wave? Will she this time allow the public who use the hospitals to see the report? Does she recognise that after the cuts at Guy's, Leeds and Bradford, the public this time will not fall for promises? The public will want to see the business plans to judge for themselves whether this time the promises about trusts are any less empty than they were last time.

Mrs. Bottomley: What is clear is that we have revolutionised the amount of information that is available about the way in which the health service is managed. We shall not make public the report from Coopers and Lybrand Deloitte. [HON. MEMBERS: "Why not?"] It will be one of the many reports to the Secretary of State giving him the information on which to base his decision whether to establish a trust, the purpose of which is to satisfy himself that better patient care will be available. That will also be safeguarded by the contract with the district health authority, which is the champion of local people and improved services.

Oral Answers to Questions — PRIME MINISTER

Engagements

Mr. Thurnham: To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

The Prime Minister: This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Mr. Thurnham: Will my right hon. Friend confirm that he has excellent and detailed plans to increase spending on public services by £38 billion in the next three years? What would be the effect of substituting an uncertain £20 billion along with socialist cuts and taxes on earnings?

Mr. Major: If a £20 billion increase were substituted for our present plans, it would certainly mean a substantial reduction in services across the board, no doubt including the health service as well. On the other hand, if there is to be £20 billion in addition to the spending plans that we have proposed, it would undoubtedly lead to large and significant tax increases across the board.

Mr. Kinnock: Does the Prime Minister think that any citizens' charter should include giving people the right to vote on whether they want their local hospitals to opt out?

The Prime Minister: In view of what the right hon. Gentleman has previously said, I am very surprised that he has so little faith in the medical people who make those decisions.

Mr. Kinnock: Even the Prime Minister must know that the "medical people", as he refers to them, whenever they have voted, have voted by majorities in excess of 80 per cent. against opt-out. [Interruption.] I will provide a list later.
Does the Prime Minister recall saying, just last Friday, that he trusts the people? Why does he not trust the people enough to allow them to vote democratically on whether they want their local hospitals to opt out? What is he afraid of? Why is he always running away from the ballot box?

The Prime Minister: Why does the right hon. Gentleman always run away from the facts? He is wrong on the subject of medical people and, as for trusting the people, we have trusted the people to make decisions more in the past 10 years than any Labour Government ever would.

Mr. Kinnock: Will the Prime Minister now answer my question? Will he give people the right to vote on whether hospitals in their localities should opt out?

The Prime Minister: rose—[Interruption.]

Mr. Speaker: Order. It is no use hon. Members' shouting, "Answer" unless they give the Prime Minister a chance to do so.

The Prime Minister: What a remarkable question from the leader of a party whose education spokesman would take away the right of parents to decide what nature of schools their children could go to.

Mr. Brandon-Bravo: To people in unskilled work, wages or a salary of £20,000 a year may seem very good pay indeed, but does my right hon. Friend feel that a level of pay of £20,000 a year makes a person rich—rich enough to be taxed at the horrendous levels now being spoken of by the Labour party?

The Prime Minister: Only a genuine Leveller would think that £20,000 a year was rich these days. Certainly, no doctors, police constables, police sergeants, fire sergeants and others would think that. The reality is that average earnings and take-home pay have risen substantially in recent years. Only the Labour party could produce taxation policies to penalise people on modest incomes. Were it to implement all its plans it would be penalising not only people on modest and average incomes but every taxpayer.

Mrs. Margaret Ewing: To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

The Prime Minister: I refer the hon. Lady to the reply that I gave some moments ago.

Mrs. Ewing: As the Prime Minister has demonstrated his intention to hold the 1992 European summit in Edinburgh, would he also accept that Scotland's international diplomatic role could best be served not by inviting Europe to our capital city for a few days every other year but by enabling Scotland to play her full international role as a member of the European Community in her own right 365 days a year, especially against a background in which the people of Scotland have shown that independence is their preferred constitutional choice?

The Prime Minister: Scotland has played a very honourable role in international affairs as part of the United Kingdom for a long time and it will continue to do so in that fashion. I am glad that the hon. Lady welcomes the fact that the European Council will be meeting in Edinburgh. It think that the people of all Scotland, but especially Edinburgh, will welcome that too.

Mr. Simon Coombs: Will my right hon. Friend confirm that the Government intend to raise £5 billion per year from the proceeds of privatisation in the next Parliament? Will he also confirm that if that revenue were not forthcoming, it would be necessary either to reduce public services dramatically or to raise taxes and to increase public borrowing to an unacceptable level?

The Prime Minister: My hon. Friend is entirely right. It would seem from what the Leader of the Opposition has said that the Labour party is planning either dramatically to increase taxation or dramatically to cut spending on public services. Privatisation has not only raised significant resources to liquidate parts of the national debt but has dramatically improved the performance of the companies

concerned. We shall continue with policies of privatisation. I think that that will be much more welcome to people than increasing borrowing on the scale that a Labour Government would envisage and increasing taxation, which is what Labour has always delivered.

Mr. Bradley: To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Bradley: To ensure that a citizens' charter for the health service has real meaning for the people in my constituency, will the Prime Minister confirm that as 100,000 people have signed a petition to protest at the proposed closure of Withington hospital and its maternity unit, and as 3,000 people joined hands around the two-mile perimeter to protest about the plan, such overwhelming support will mean that citizens have the right to retain their local hospital and that the Government have a right and duty to honour their views?

The Prime Minister: As the hon. Gentleman knows, matters of that sort are dealt with in the first instance by the health authority, and I think it is better that they should be. What I can tell the hon. Gentleman about the citizens' charter—an idea that I first began to consider and to speak publicly about in 1987—is that it will provide far greater redress for the citizen than ever before.

Sir Richard Luce: Is it not becoming clearer day by day that the Labour party is coming out in its true colours as the party of high spending and high taxation—

Mr. Speaker: Order. The right hon. Gentleman must ask a question about the Prime Minister's responsibility.

Sir Richard Luce: Did not my right hon. Friend reflect when he got up this morning that the Labour party is coming out in its true colours—

Mr. Speaker: Order. That is no good.

United Nations

Mr. Cryer: To ask the Prime Minister when he next expects to pay an official visit to the United Nations.

The Prime Minister: I have at present no plans to do so. However, I am in regular contact with the secretary-general.

Mr. Cryer: In view of the withdrawal of the Valiant Churchill class of nuclear submarines due to dangerous defects in their nuclear reactors, would it not be prudent for the Prime Minister to withdraw all Polaris nuclear submarines, which have identical defects in their nuclear reactors? At the same time, he could cancel the Trident programme and announce that his Government are supporting the United Nations—[Interruption.]

Mr. Speaker: Order. Hon. Members should give the hon. Gentleman a chance to get to a conclusion.

Mr. Cryer: The Prime Minister could announce that his Government were supporting the United Nations nuclear non-proliferation treaty; the 141 states which have signed that treaty have pledged not to deploy or manufacture nuclear weapons.

Mr. Speaker: Briefly, please.

Mr. Cryer: Billions of pounds could then be released for the national health service in this country and for the millions of poor in other countries throughout the world.

The Prime Minister: Someone spoke a moment ago about the true face of the Labour party. I think that we have just heard it. I happen to be in favour of our maintaining a nuclear defence. That will be our position in the future. I am interested to learn from what the hon. Gentleman has said that that may not be the position of the Opposition.

Engagements

Mr. Roger King: To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Mr. King: Does my right hon. Friend agree that education, and particularly the quality of that education, are paramount in many people's minds? Is he aware that in Birmingham we have excellent grant-maintained grammar schools which are under threat from the local Labour council, which intends to strangle them to death so that there is no choice for the people of Birmingham, despite 96 per cent. of them saying that they want their grammar schools maintained? Will my right hon. Friend join me in supporting educational excellence.

The Prime Minister: I was not aware of that proposal, but I am unsurprised to hear that that is the view of the Labour local authority; it clearly has no concern for the views of parents about education—a point which the Leader of the Opposition neglected to mention. As a general principle, I agree with my hon. Friend that the Labour party opposes choice on assisted places, on city technology colleges and on grammar schools. Its top priority on day one, as the hon. Member for Blackburn (Mr. Straw) said, would be to take away parents' choice to keep their schools independent of council control.

Mr. Ashdown: As the Prime Minister has registered that some in his party regard the proposals put forward by our European partners next week on monetary union as a fudge, and as one of his Ministers has said that they are a fraud, although many others will see them as Britain's last opportunity to be at the heart of Europe rather than its periphery, will he now tell us his view of the proposals? Are they a fudge, a fraud or an opportunity not to be missed?

The Prime Minister: We are at a very early stage in the negotiations on economic and monetary union and on political union. As to the proposals to which the right hon. Gentleman referred, my right hon. Friend the Chancellor told the House in January that
the Government have made it plain to our European partners that we cannot accept any changes to the treaty of Rome which would bind us to a single currency or a single

monetary policy without a separate decision by the United Kingdom Government and Parliament."—[Official Report, 24 January 1991; Vol. 184, c. 470.]

Mr. Michael Morris: To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Morris: Is my right hon. Friend aware that the evidence is that, in local government, competitive tendering has given the public good value for money? Does not that mean that we should have similar policies throughout the public sector, including the national health service?

The Prime Minister: My hon. Friend has considerable knowledge of the health service and he is, of course, entirely right. Abolishing competitive tendering for support services would threaten the loss of the savings of £150 million a year that have been achieved in the national health service thus far. Opposition to those improvements and to efficiency improvements worth £400 million could only remove more than £500 million from the health service, year after year after year. That is the policy of the Opposition, but not of the Government.

Mr. Peter Archer: To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

The Prime Minister: I refer the right hon. and learned Gentleman to the reply that I gave some moments ago.

Mr. Archer: Does the right hon. Gentleman recollect that, prior to the last election, the Government gave a categorical assurance that if re-elected they would not increase VAT? Bearing in mind that, having been re-elected, the Government doubled VAT, will the Prime Minister invite the electorate to believe future election promises? If so, can he now say categorically whether the Conservative party, if re-elected, will increase VAT further?

The Prime Minister: Characteristically, the right hon. and learned Gentleman is telling only half the story. He utterly neglects to mention the fact that there was precisely corresponding reduction in local tax by way of the reduction in the community charge.

Statutory Instruments, &amp;c.

Mr. Speaker: With the leave of the House, I will put together the two motions relating to statutory instruments.

Ordered,
That the draft Criminal Justice (International Cooperation) Act 1990 (Enforcement of Overseas Forfeiture Orders) Order 1991 be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Drug Trafficking Offences Act 1986 (Designated Countries and Territories) (Amendment) Order 1991 be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. Patnick.]

Points of Order

Mr. Patrick Nicholls: On a point of order, Mr. Speaker. I seek your guidance about an exchange of correspondence to which some of today's newspapers refer. Apparently, there has been an exchange of correspondence between my right hon. Friend the Chief Secretary to the Treasury and the Leader of the Opposition. In his letter, my right hon. Friend calls upon the Leader of the Opposition to clarify how the next Labour Government would spend more than the present Government by actually spending less—

Mr. Speaker: Order. I see that the hon. Member has a copy of "Erskine May" in his hands. So have I. Can he come to a point of order for me? I am not responsible for exchanges of letters.

Mr. Nicholls: It is indeed a point of order for you, Mr. Speaker. It touches on your responsibility for the Library of the House, to which "Erskine May", on page 196 of the 21st edition, refers. I have been able to ascertain that the Chief Secretary's letter is in the Library. Can you, Sir, take steps to ensure that the response will be available in the Library within the next 24 hours?

Mr. Speaker: So far as I know, it has never been the responsibility of the Chair to see that exchanges of that kind are placed in the Library.

Mr. Gerald Bermingham (St. Helens, South): On a point of order, Mr. Speaker. The Secretary of State for Health is still in his place. In answer to question No. 9 from the hon. Member for the Isle of Wight (Mr. Field), during the chaos of Question Time—

Mr. Speaker: Order. This sounds like an extension of Question Time. What is the point of order for me?

Mr. Bermingham: The point of order is that the Secretary of State, in reply to the question, indicated that a member of the British Medical Association, who happens to be a doctor in the Isle of Wight, ought not to perform his functions as an elected member, but should stay in his surgery. It has always been a convention of this House—

Mr. Speaker: Order. I am not responsible for questions that are asked or for answers that are given, provided that they are in order. So far as I am aware, these were in order.

Mrs. Alice Mahon: On a point of order, Mr. Speaker.

Mr. Speaker: Does the hon. Lady wish to take time from that allotted to the Opposition?

Mrs. Mahon: On a genuine point of order, Mr. Speaker.I wonder if you have received a communication from a constituent of mine who is writing to you about a £364,000 city grant given to Barratt, the building company, to build homes in my constituency. My constituent wrote to you because of serious allegations that have arisen in recent days. On receipt of that communication, would you allow time for an inquiry into those allegations about the misuse of public funds?

Mr. Speaker: I have to say that I have not received that letter, although I receive a wide range of letters from members of the general public. At first sight, I cannot see that it has much to do with me. However, when I receive the letter, I shall consider it carefully.

Opposition Day

[IITH ALLOTTED DAY]

Health Service and Community Care

Mr. Speaker: I must announce to the House that I have selected the amendment in the name of the Prime Minister.

Mr. Andrew Mitchell: On a point of order, Mr. Speaker.

Mr. Speaker: Order. I am on my feet.
Many right hon. and hon. Members are seeking to participate. I have no authority to propose a 10-minute limit on speeches in a half-day debate, but I hope that hon. Members who are called to speak will be brief so that many of their colleagues can participate. What is the hon. Gentleman's point of order?

Mr. Mitchell: I seek your guidance, Mr. Speaker. There is a ten-minute Bill on the Order Paper in the name of a Labour Member.

Mr. Speaker: Order. I said that it is perfectly in order for an hon. Member who, for good reasons which he has explained to me cannot be present, to withdraw his motion.

Mr. Mitchell: The point on which I seek your guidance, Mr. Speaker, is that the Bill dealt with removing restrictions on immigration. It is extremely offensive to me, to many of my hon. Friends and to many of my constituents. It is, however, an important matter, and I seek your guidance as to whether it might be—

Mr. Speaker: Order. It is perfectly in order for an hon. Member who cannot be present not to move his motion, and that is what has happened today. Nothing out of order has occurred.

Mr. Robin Cook: I beg to move,
That this House records its concern at the damage to the National Health Service from the implementation of the National Health Service and Community Care Act; condemns the pressure created by the new system for a two-tier health service in which waiting time is determined not by clinical need but by commercial priorities; is disturbed that the introduction of block contracts had reduced patient choice of hospital and restricted general practitioners' freedom of referral; regrets the shortage of people representative of their local community among the businessmen appointed by Her Majesty's Government to decide local health priorities; notes with alarm the financial instability that has already become evident among hospitals that have formed self-governing trusts; deplores the decision of the Secretary of State to approve 57 health units for trust status despite advice that there were financial problems with 45 of them; and calls upon Her Majesty's Government to abandon its plans for a second wave of health units to form such trusts.
It is just under four weeks since the House last debated health, yet so much has happened in those four weeks that it is almost unkind to remind Ministers of what they said in that debate.
The Secretary of State for Health took pleasure in the fact that the changes had been introduced with, as he said,

"no significant problems." The Minister of State, eight days before the cuts were announced at Guy's hospital, announced to the House:
It will not be long before the noise about trusts…abates."—[Official Report, 17 April 1991; Vol. 189, c. 512.]
I took the precaution of checking Hansard last night in the Library in case a member of the Prime Minister's private office had been down with an errata slip.
My favourite passage was from the Secretary of State's speech in which he complimented the British Medical Association on—in his words—moving on and "becoming sensible." The Secretary of State will have followed with interest the views expressed by the new, sensible BMA over the past couple of weeks, culminating last Thursday after his meeting with it when it reported:
the Secretary of State was not open to reason.
That is from the very medical people who, 20 minutes ago, the Prime Minister said should take the decisions on whether a hospital should seek self-governing trust. Try telling that to the BMA.
There have been two developments since our last debate, which have given Ministers' speeches a near-comic irony which they lacked on first hearing. First, events have exposed the gulf between what Ministers promised as a result of the changes and the real effect of the changes. Last autumn, staff at Guy's were promised that the hospital would make a surplus of £1·5 million in its first year of trading. A month after the new system was introduced, the same staff at Guy's were told that the hospital was predicting a deficit of almost £7 million. At the beginning of April, the staff at Guy's received a circular from Mr. Peter Griffiths in which, under the heading "We are friendly and we are fun", he assured the staff:
The management cares, really cares, about people, about their staff.
At the end of April, 600 of the staff who had received that letter discovered that they might be made redundant over the next two years.
Whenever I refer to trusts as opting out, Conservative Members shout me down. I am bound to say that nothing has more convinced the public that a hospital that has formed a trust has opted out than the speed with which Ministers let it be known, when the cuts at Guy's became evident, that Guy's was on its own, that it was no responsibility of theirs, that what the board of directors did to staff jobs or patient care had nothing to do with them.
The Secretary of State cannot have it both ways. He cannot on the one hand assure us that trusts have not opted out and, on the other hand, wash his hands whenever they hit trouble. He cannot have it both ways, because his own reputation is on the line. He approved the very business plan that is now in such trouble. The Secretary of State has not been allowed by the media to ignore the crisis at Guy's.

Sir Anthony Grant: What trouble?

Mr. Cook: The hon. Member below the Gangway asks, "What trouble?" I do not know whether the hon. Gentleman has been out of the country for the last four weeks, but the rest of the nation knows that the trouble at Guy's is the turnround of a £1·5 million surplus, as promised in the business plan last autumn, to a £7 million deficit, with a 10 per cent. cut in staff and the dropping of


whole specialties. If the hon. Gentleman does not recognise that as trouble, I do not know what he would recognise as trouble in the health service.
I was intrigued to note that the Secretary of State has now produced a novel defence of the new structure. I paraphrase his argument, but the nub of it—rehearsed several times on television and rehearsed again a few moments ago at Question Time—is that there is too much hospital capacity in London, that the advantage of the new commercial competition is not that it will strengthen the London hospital service but that it will show which London hospital should go under. On that basis, it is no doubt sensible to throw in a few high-risk cases such as Guy's.
If it is the Secretary of State's view that the problem is that there are too many hospitals in London, I cannot imagine a worse solution than throwing them all out into the market to see which sinks. We cannot plan an essential public service by waiting to see who goes bankrupt. While we wait, as the Universities Funding Council reminded us last week, we could disrupt the training of a whole generation of medical students.
I must remind the Secretary of State that the House was not sold the Government's changes on the basis that they would show which hospital should close. The Secretary of State is still comparatively new to his portfolio. He is the third Secretary of State that we have had during the process of these changes. Now that the general election is unlikely to be held until 1992, we have time for a fourth.
May I remind the right hon. Gentleman, however, that the national health service review that led to these changes was born out of the closures in the winter of 1987–88? It was presented to the House as the solution to those closures. The right hon. Gentleman's predecessor was lavish with his promises. There were promises about what would happen after the changes—that money would follow the patient. As we all know, there is never any shortage of patients. The implication was that, when money followed the patients, there would be no shortage of money, either.
I treasure in particular this passage from the speech of the right hon. Gentleman's predecessor in January 1990.
Next year,
he said,
in April 1991, we propose to reform the NHS: the coming winter will end the last year of an entirely unreformed service. The winter of next year will not be dominated by cancelled operations, closed wards and cuts in services".—[Official Report, 11 January 1990; Vol. 164, c. 1124.]
Indeed not. The net effect of the changes has been to bring the cuts and closures forward this financial year from the winter to the spring.
A whole new lexicon of cuts is being used in the Minister's Department. I saw the other week an internal Department of Health memorandum which no longer talks about closing wards but about "downsizing hospitals". I noticed last week that Guy's no longer talked about specialties but about "reprofiling services".

Mr. Kenneth Hind: The flaw in the hon. Gentleman's argument is that the purchasers of health care in and around the environs of London have realised that they do not have to send their their patients to London teaching hospitals. They can send them down the road to the local district general hospitals. When the

hon. Gentleman talks about NHS trust hospitals, he fails to look at the same time at the same problem that is being faced by those that have not yet opted out.

Mr. Cook: I have heard that argument before. I noticed with interest that Dr. Ken Grant deployed it in relation to the problems that he faces at Bart's. Hon. Members who represent districts in the inner city of London and deprived areas such as Hackney, which Bart's serves, find it incomprehensible that if, all of a sudden, there is spare capacity as a result of people from the home counties no longer coming to London, waiting lists in their areas for their constituents continue to grow.
They find it unacceptable to be told by the manager of Bart's that they will have to admit people from Essex in two weeks when they cannot admit people from Hackney within a year. If that surplus capacity is there, surely we should be using it for the people served by those hospitals.
I was recalling the new way in which cuts, which occur not just in London, are described. My hon. Friends who represent constituencies such as Bradford, Leeds and Newcastle have talked about the cuts that are now being made by trusts in their cities. Nor are just trusts in difficulty. One of the most breathtaking interviews that the Secretary of State gave in the wake of the crisis at Guy's was when he defended the trusts against criticism by pointing out that other hospitals that were not trusts were in just as big a financial hole. I congratulate the right hon. Gentleman on his candour, although I do not understand why he imagined that viewers would be reassured by the news that trusts were all right because everybody else was in the same financial boat.
From a flurry of press cuttings on closures—I should refer not to closures but to the downsizing of hospitals that are now trusts—I single out one. That is about the closure two weeks ago of a ward for elderly patients in Bath. I choose that press cutting because the report was accompanied by a charming photograph of the right hon. Member for Bath (Mr. Patten), the Chancellor of the Duchy of Lancaster, shown smiling beside a plaque recording that it was opened by him in October last year.
I could find no better illustration than that photograph of the gulf between what was promised and what has happened. It was a photograph taken the month before the right hon. Gentleman became chairman of the Tory party, showing him opening a ward. That very ward, within four weeks of the changes introduced by the Government, has been reprofiled and closed.

Mrs. Maureen Hicks: I recall that, only a year ago, the hon. Gentleman, when making a financial assessment of the requirements of the NHS, maintained that, if we injected just £3 billion, all our problems would be solved—that no reforms or control of union power in hospitals would be necessary, and all would be magic. Since then, an extra £6 billion has been injected into the NHS. Is he aware that, if he continues to ignore the need to reform the NHS, no progress will ever be made?
I am increasingly coming to the view that the hon. Gentleman is interested only in orchestrating events to take advantage of vulnerable people who depend on the NHS—[Interruption.]—and he is playing, as he knows, into the hands of the unions.

Mr. Speaker: Order. This sounds like a good speech for later on.

Mr. Cook: Will the hon. Lady allow me to intervene? I did not produce a figure of £3 billion but quoted the estimate of the National Association of Health Authorities for the cumulative underfunding of the health service. She was right to say that, when I quoted that figure in the spring of last year, that organisation's estimate for cumulative underfunding was £3 billion. In view of the hon. Lady's complacency about the funding of the health service since then, she should know that the National Association of Health Authorities has now revised that figure to £4·5 billion.

Mr. Phillip Oppenheim: Will the hon. Gentleman give way?

Mr. Cook: I shall give way to the hon. Gentleman—

Mr. Speaker: Order. The hon. Member for Livingston (Mr. Cook) was seeking to answer a point that was put to him. It would be disruptive to have another question before he has finished answering the first.

Mr. Cook: I shall seek to give way to the hon. Gentleman when I can, as he is always worth it.
The figure of £4·5 billion is extremely interesting. The Chancellor of the Exchequer produced precisely the same figure out of a hat to deaden the political pain of the poll tax. If Conservative Members can find £4·5 billion to save their political skins, they can find it to save the national health service.

Mr. Oppenheim: While the hon. Gentleman is on the subject of funding, did not the shadow Chief Secretary originally tell the House that the only priorities under a future Labour Government would be pensions and child benefit? The hon. Member for Livingston then told the House that spending on health would also be a priority. However, the Leader of the Opposition has just told us that spending on the health service would increase only in line with economic growth. Is not the Labour party playing its old cynical game of trying to be all things to all men as usual?

Mr. Cook: I have the advantage over the hon. Gentleman, because I heard my right hon. Friend make his speech, and very well received it was, too. I know that my right hon. Friend said no such thing—[Interruption.] I merely seek to serve. My right hon. Friend the Leader of the Opposition said that the extra tax that comes from growth should be used for health and other essential services, which is entirely different from the slant being put on it by the hon. Gentleman and the Secretary of State, who imply that the Labour party was committing itself to spending no more on health than the growth of the economy. As my right hon. Friend said, that extra money will ensure that underfunding can be tackled from the start.

Sir Nicholas Bonsor: Will the hon. Gentleman give way?

Mr. Cook: I should like to return to my own speech at some stage, but I shall make a bargain with Conservative Members. I shall give way now to any Conservative Member who can explain to the House and to the country how the Government propose to find £30 billion to reduce the basic rate of tax, without ripping it out of the national health service.

Mr. Jerry Hayes: Will the hon. Gentleman give way?

Mr. Cook: Yes, I knew that the hon. Gentleman would not fail me.

Mr. Hayes: The hon. Gentleman is a man of great integrity. After all, he voted against the 48 per cent. rise in waiting lists when the Labour party was last in office. Nevertheless, he has proposed a simple challenge. There is something called the Laffer curve, and I suspect that the last Laffer will be that of the Conservative Government. Quite simply, we have reduced taxes, as opposed to the plans of the hon. Member for Livingston (Mr. Cook), who intends to increase them. In 1979, the top 5 per cent. of taxpayers were paying—[Interruption.] The hon. Gentleman should listen carefully, because he asked a question—

Mr. Speaker: The hon. Gentleman was challenged by the hon. Member for Livingston (Mr. Cook) but should come to the point, not make a speech which he might make later.

Mr. Hayes: I shall make it clear—in 1979, the top 5 per cent. of British taxpayers contributed 24 per cent. of the volume of taxes coming in to this country. Since the Conservative Government reduced taxes, the top 5 per cent. now contribute more than 31 per cent.—which means that there is more money for the health service. We are able to cut taxes and spend more money on public services, which is more than a Labour Government could ever do.

Mr. Cook: My question was about a cut in the basic rate. The hon. Gentleman referred simply to cuts in the top rate. We should welcome the insight that he has given us into what will happen if the Conservatives are re-elected—the clear sign is that they will cut the top rate. If the hon. Gentleman hopes to sell the paradox that he offers the House today, even to the good electors of Harlow, he must explain why, whenever the Government cut the rate of income tax, they have to compensate by increasing indirect taxation through VAT, which people who may well not pay income tax will have to pay when they buy their goods in the shops.
We have had good, clean, knockabout fun, which I thoroughly enjoy, but I shall now return to my speech. There is no better illustration of the gulf between what Conservative Members promised and what happened than that photograph of the Conservative party chairman. I want to leave the last word on the emptiness of the rhetoric that the Government wrapped around the reforms to Lothian health board, which has just dropped from its stationery and logos the term "Putting Patients First". That logo was dropped from all publications by the Lothian health board last week because, as its manager revealingly said on Sunday,
management figures are sick of having the phrase used as a stick to beat them"—
[Laughter.]—my hon. Friends have missed the punch line—
every time they make cuts".
There has been only one poll since the Government ran into problems with its NHS changes. Last week, a poll carried out by The Scotsman found that 58 per cent. of those replying believed that the Government changes would make the health service worse. A total of 9 per cent. believed that it would increase the health service. That


response makes even the poll tax—the Secretary of State's last invention—look like a runaway success in popular support. It is not the Labour party but the voters who are currently making health the main issue of the Monmouth by-election and who will make Thursday's vote a referendum on NHS changes.
That prompts me to ask my next question of the Secretary of State. Given the overwhelming rejection by the public of those changes, how can the Secretary of State persist with his plans for a second wave of more than 100 hospitals to opt out and form trusts? Why does he not let people decide for themselves in a general election, which not even this Prime Minister can keep putting off for ever? If the Secretary of State does persist in his plans, and as the hospitals contemplate opting out, will he let the staff at those hospitals have a proper ballot?
I ask that question because the Conservative Monmouth candidate said that such a ballot would be "sensible and proper". Does the Secretary of State endorse the candidate's view? I would not ask the Secretary of State to endorse all the views of the Conservative candidate in Monmouth—I realise that that would be too painful—but will he endorse this one? It looks as though he could do with a lifeline. Or are we to take it from the Secretary of State's silence that on that point, as on so many others, the Conservative candidate for Monmouth is an embarrassment to his party?
The second development since our debate last month—

Sir Nicholas Bonsor: I am grateful to the hon. Gentleman for giving way, especially in view of the pressure of time. He should not give too much weight to what the candidates in Monmouth say—[Laughter.]

Mr. Speaker: Order. These interruptions take up a great deal of time.

Sir Nicholas Bonsor: —given that the Labour party candidate in Monmouth is putting up an appalling performance.
Does the hon. Gentleman acknowledge that efficiency in hospitals is essential in order to give patients a proper service? Does he not realise that hospitals under the NHS have been unable to account properly for the use of blankets, penicillin or anything else allowed for in their budgets? Because they have not had proper hospital accounting, they have not been able to deliver the service to patients. Is it not right to insist that hospitals have proper accountability and economic controls? Surely that is the best way of doing things.

Mr. Cook: I shall make a deal with the hon. Gentleman. I shall offer to concede that, as in any multi-million pound business—the NHS is a multi-billion pound business—there are always opportunities—[HON. MEMBERS: "Answer the question."] I am trying to use language that Conservative Members will understand. There are always opportunities for greater efficiency and greater savings; I would not deny that for one moment. But does the hon. Member for Upminister (Sir N. Bonsor) agree that the worst cases of waste that we have witnessed in the NHS have involved surgeons being paid salaries to stand idle and do no operations, operating theatres paid for and equipped but not used, and wards lying empty because

hospitals cannot afford to admit patients? That is waste and inefficiency on a colossal scale, which dwarfs potential savings on blankets.
The second development since our previous debate is that events have proved how right Opposition warnings were. We warned that the new commercial system would result not only in less choice, but in a less fair health service. We warned that, if hospitals were to survive by making money from contracts, they would be quick to give priority to the contracts that made the most money. They have indeed been quick to do that. There have already been several sightings of GP fund holders securing a fast track to put their patients in front of everyone else. One of the directors of the board at Watford observed as much, when he said:
the board are aware that the implication of agreeing these contracts is a two-tier service.
Appropriately, that statement was made by the new marketing manager of Watford hospital.
There is a simple way to describe the new arrangements—queue-jumping. Over the past week it has been fascinating to see how Ministers have tried to defend and deny the double standards in patient care that break out on a waiting list when a market behaves like a market. On Tuesday, the Prime Minister was still trying to maintain that admissions would be made according to clinical priority—the only difference, presumably, being that, since 1 April, clinical priority has been decided by marketing managers. By Thursday, his position had been overtaken by the evidence. The Secretary of State defined a new bolthole for Ministers, drawing a distinction between urgent cases, which must be dealt with according to what he described as proper priorities, and non-urgent cases, for which it is presumably acceptable to use the improper priorities of the market.
Let us not deceive ourselves by the comfortable term "non-urgent". When we speak about non-urgent patients, we mean elderly women who are crippled and housebound because they cannot get a hip replacement operation, about middle-aged men who cannot work because of a painful hernia, and about pensioners going blind because they need a cataract operation. The right hon. Gentleman may describe such people as non-urgent patients, but they are people suffering from pain, discomfort and indignity, who want an urgent cure. How can Conservative Members justify admitting such people in order of commercial priority? How will they sell that to patients at the end of the queue?
It is not only GP fund holders who are producing the double standard on waiting lists. Last week, I published correspondence from Alderhey children's hospital in Liverpool, a hospital which formed a trust in the first wave. That letter bluntly told north-western districts that Mersey district had agreed to pay a premium for each case of child heart surgery. The letter said that, unless the north-western districts agreed to pay the same premium,
It is not … possible for us to guarantee that any children currently waiting will be treated in the financial year".
There is no mention there of clinical priority.

The Secretary of State for Health (Mr. William Waldegrave): I am used to the stories that the hon. Gentleman puts about, which turn out on closer examination to be not quite what they seem. As he knows, for many years we have had money which is used to diminish waiting lists. All that the hon. Gentleman's story shows is that various districts were choosing from among


their many priorities those to which they would apply waiting list money. Some chose to put it into a specific branch of paediatrics and others did not.

Mr. Cook: I am not making up a letter from Alderhey hospital. Not only have I seen that letter: I have seen the reply from North Manchester health authority, which properly and vigorously says that that authority has a contract with Alderhey hospital. The pricing of that contract is at less than half the premium that Alderhey now demands for each case of child heart surgery. North Manchester health authority says that Alderhey hospital must now admit those children on the basis of clinical need and priority, and not on the basis of the commercial price that Alderhey seeks.

Mr. Waldegrave: The hon. Gentleman does not understand. The hospitals told the districts that, if some of that waiting list money could be used for this specialty, extra wards could be brought back into use. There is nothing whatever wrong with that. It would not have threatened existing contracts, and more children could have been treated. I am sorry that the hon. Gentleman still does not understand that.

Mr. Cook: Apparently I am not the only one who does not understand the letter from Alderhey hospital; nor does the general manager of North Manchester health authority. He lives closer to the scene than the Secretary of State, he deals regularly with Alderhey hospital, and he has negotiated a contract with it and is therefore better placed than the Secretary of State fully to understand the meaning of the letter, which states:
It is not … possible for us to guarantee that any children currently waiting will be treated in the financial year".
There is only one way to understand the meaning of those words, which were addressed to districts who paid double the price. Such a double standard has no place in a public service.
Delays in children's heart surgery at Birmingham drove the Government into setting up the NHS review. Perhaps a two-tier list for children's heart surgery will finally discredit the outcome of that review and will demonstrate what happens when the national health service is run as a commercial business. Labour will scrap this market in health care and bring back into the local health service hospitals such as Alderhey which have gone it alone as trading enterprises. We will restore the NHS as a public service, as we have done before.
Before the Secretary of State tries his hand again at a historical novel and distorts the record of the last Labour Government, I shall tell him about that record. [Interruption.] I am happy to say that we do not intend to rewrite history. I shall quote from an answer received by my office on Friday from the Department of Health.
The Secretary of State will recall that, during an earlier debate on the national health service, he taxed me with the claim that, under the Labour Government, there was only one year when there was a cut in real terms in spending on health. The Opposition asked his Department to provide us with the figures on the real terms volume expenditure on the health service. As the figures came from the right hon. Gentleman's office, I think that we can be sure that they have been pored over to cure them of any Labour bias.
I have to report to the House that the figures produced on Friday in Hansard show nothing of the sort that the right hon. Gentleman asserted. Under the Labour

Government, there was a steady increase every year in volume spending. There is one year, however, in which health spending in real terms fell by 1 per cent., and that was 1979, the first year of the Conservative Government's term of office.

Mr. Waldegrave: The hon. Gentleman has been misled. If that has happened as a result of an answer from my Department, I apologise to him. The figures are clear. I know exactly the mistake into which the hon. Gentleman has fallen. If the figures are taken on the basis of a calendar year, which does not include the additional moneys that are produced regularly towards the end of the year—for example, pay review bodies—the result is that which the hon. Gentleman has described. However, the year-on-year figures, which have been published for many years, show only one year in the history of the health service when there was a revenue cut, and that was 1977–78.

Mr. Cook: I accept that the right hon. Gentleman genuinely did not seek to deceive the House, and really believed in what he said. Knowing the problem that there might be in convincing him of the reality, I have brought with me the relevant edition of Hansard. It—[Interruption.] I am not surprised that the hon. Member for Esher (Mr. Taylor) is running backwards and forwards from his seat behind the Secretary of State to the Box, he being the right hon. Gentleman's Parliamentary Private Secretary.
At col. 491 on 8 May, there is an answer from the Under-Secretary of State for Health, who has been accused of misleading me. I wish to spring to his defence and to say that I have never known him deliberately to mislead. The figures are set against the years. The years are 1974–75 and 1975–76 through to 1989–90 and 1990–91. I think that the Secretary of State now has the answer in front of him. His Department provided financial year figures that do not record that which he suggested in our previous debate.

Sir Anthony Grant: Will the hon. Gentleman give way?

Mr. Cook: No; this is a private quarrel.

Mr. Waldegrave: The figures show that there was only one year, 1977–78, when there was a cut in spending.

Mr. Cook: I shall read out the figures. In the financial year 1976–77, total spending on the NHS was £18,617 million. In 1977–78, it was £18,889 million. In 1978–79 it was £19,606 million. The figures make it clear that there was no cut. There was a cut, however, in 1979–80. The Government are the people who tell us that their accounting methods are better than those that are to be found in the health service. They are the people who lecture managers that they are unable to obtain proper information and proper costings of operations in the health service. At the same time, they cannot agree on the terms of a parliamentary answer.

Mr. Waldegrave: I shall give the hon. Gentleman the gross total of NHS expenditure at 1991–92 prices. That is real prices. For 1975–76, the spending was £21,568 million. It was £21,689 million for 1976–77 and £21,155 million for 1977–78.

Several Hon. Members: rose—

Mr. Speaker: Order. May we have one at a time—and would it not be a good idea if we got on with the debate?

Mr. Waldegrave: I have been talking about the health expenditure figures. Is the hon. Member for Livingston (Mr. Cook) talking about the undivided departmental figures?

Mr. Cook: I am talking about the NHS total figure, with which column 491 of Hansard has provided me. If anyone has got the figures wrong, it is the Parliamentary Under-Secretary of State.
You kindly suggested, Mr. Speaker, that, as we had plainly won this exchange, it was now time to move on. I was interested to note—

Sir Anthony Grant: Will the hon. Gentleman give way?

Mr. Cook: No, I will not. I was interested to note that on Friday—

Sir Anthony Grant: rose—

Mr. Cook: No, I must press on.

Mr. Speaker: Order. I have already pointed out that a great many hon. Members wish to participate. This is becoming a kind of Committee stage.

Mr. Cook: On Friday—[Interruption.] I must ask my hon. Friends to allow me to proceed.
On Friday, the Secretary of State produced a new illustration of the contrast between his Government and ours. He made a speech in which he attacked me as well as the Labour party—and vulgar stuff it was; not the stuff of which he carved his intellectual reputation at All Souls. This was definitely gamma minus stuff. He said:
We have dramatically increased the numbers of doctors and nurses working in the NHS.
I am sorry to say that the right hon. Gentleman's ministerial colleagues have let him down again: they have produced the figures.
Throughout the 1980s, the number of doctors increased by 18 per cent. That is a comfortable increase, for which I will not deny credit to Conservative Members. During the period of the last Labour Government, however, the number of doctors increased by 25 per cent.—and that was over five years, not 10. The rate of increase was three times as fast as the annual rate under the present Government.
The right hon. Gentleman's colleagues have also been very helpful in providing the figures relating to nurses. If we take the increase in whole-time equivalents on the same basis, we find that, in the 10 years of the present Government's tenure, the number of nurses in our wards increased by 6 per cent.

Sir Nicholas Bonsor: What about the numbers?

Mr. Cook: I am talking about the numbers. Under the last Labour Government, the number increased by 14 per cent., at nearly four times the annual rate. The Secretary of State spoke of a "dramatic increase". What superlative—what hyperbole—would he find to describe the record of the last Labour Government, which is three or four times better than his Government's record?

Several Hon. Members: rose—

Mr. Cook: I will not give way.
The question for the right hon. Gentleman is this: how can he hope, at the next general election, to persuade the voters that he will do any better next time round, when sitting beside him is a Chancellor who wants to rip £30

billion out of public spending? Where will that £30 billion come from, and how much will come from the health budget?
At the next election, the electorate will have a clear choice between a Labour party that is committed to using the increase in revenue to restore the NHS and essential services, and a Conservative party that is committed to using it to pay for tax cuts. The need for that choice to be made could be seen clearly last night at King's College hospital in Camberwell. Yesterday evening, 14 people were admitted to the accident and emergency department. They had to remain lying on trolleys in the casualty room, because no beds could be found for them. Last November, the hospital closed 120 beds to meet the Secretary of State's deadline of 1 April for the elimination of the hospital's deficit. Those 14 people included an 89-year-old woman who was blind and had suffered a fall, and a 16-year-old boy who was vomiting blood. They were all lying on trolleys 9 in apart. That is the real price of underfunding of the health service. That is the real price being paid for the commercial priorities of this Government. And those are the people who cannot afford a 5p cut in the basic rate.
There is only one good consequence of the events of the past month: the Secretary of State and his changes have put the health service back in the centre of the stage. Some of his colleagues may well doubt whether that was wise, because the NHS occupies the fault line between our values and theirs. It is clear that some activities are too important to be left to the market, that there are some public services that are not just fairer but more efficient when they are planned to meet social needs and not driven by chasing market forces.
It is because, as hon. Members have just shown, they are incapable of understanding that the NHS is not safe in their hands. That is why the electorate now have a clear choice between losing their NHS under this Government or renewing it under a Labour Government.

The Secretary of State for Health (Mr. William Waldegrave): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
welcomes the progressive implementation of the Government's reforms of the National Health Service, coupled with substantial increases in resources for the National Health Service and in the numbers of patients treated since 1979; looks forward to the benefits of these reforms being spread more widely so that services everywhere are brought up to the standards of the best, especially with the further development of National Health Service trusts and fundholding practices; notes that district health authorities and general practitioner fundholding practices will both give priority to patient's clinical needs; welcomes the determination of the new National Health Service trusts to get to grips with long-standing management problems; supports the new role of district health authorities as guardians of the public health, accountable for arranging comprehensive care for their local residents; and endorses the Government's intention to set out a new agenda for the National Health Service which concentrates more than ever on improving the health of the people.
As the sound and fury of political debate declines for a moment, commentators are beginning to see that there are two issues on which the Labour party has staked out its ground. First it claims that its members would be better than we are at producing resources. Secondly, it claims that it would be better at getting those resources to where


they are needed within whatever constraints are imposed. Both sides are agreed that this service will remain cash limited.
The Labour party remains in trouble about money, as usual. The anxiety of the right hon. and learned Member for Monklands, East (Mr. Smith) to appear respectable in the City has completely undermined the series of costed and uncosted, bogus and less bogus pledges made by his hon. Friend the Member for Livingston (Mr. Cook). Every lobby which writes to them gets a nod and a wink, indicating that there will be more money for its particular cause.
The pit into which the right hon. and learned Member for Monklands, East, with the able assistance of the Leader of the Opposition, has now dug the Labour party was demonstrated to listeners to "Today" yesterday, I think, when the right hon. and learned Member for Monklands, East was comprehensively carved up by my right hon. and learned Friend the Chief Secretary to the Treasury. We simply do not now know what Labour Members mean by their spending pledges, and it is increasingly clear that neither do they.
First, our record in office is better than Labour's. Labour increased spending on health by about 1·5 per cent. in real terms; we have increased it by about 3·2 per cent. in real terms. We have done better than Labour said that it would have done in 1987 had it been elected. The Labour party promised an increase of 3 per cent. in real terms in 1987 and we have provided a 3·5 per cent. increase in real terms since 1987. Both in the reality and in the promises, our word has more reason to be trusted by the electorate then Labour's.
Furthermore, as has already been pointed out, the hon. Member for Livingston has failed to achieve what many Labour Back Benchers might feel it was his duty to achieve—to place the health service among the principal priorities of the Labour party in the run-up to the next election.
Why should anyone believe that the hon. Member for Livingston would be any better in dealing with the right hon. and learned Member for Monklands, East if Labour were in power than he has been in opposition? He has not won the argument with his right hon. and learned Friend in opposition and he would not win it if Labour were in power. It is far more likely that, if the Labour party were to find itself in power, events would be just as they were last time. I stand completely firmly on the figures, which show that, in 1977–78, Labour cut spending on the health service in real terms and cut the capital spend throughout its period in office.
When I last raised that matter with the hon. Member for Livingston—it clearly distresses him to have to remember what happened when Labour was in power—he said, rather lamely, that he had voted against the 1975 White Paper. Well, his memory deceives him. He did not. He abstained. Some of the Opposition Members below the Gangway were more consistent. They voted against it all right. But the hon. Member for Livingston was not to be found in the House on that occasion. That once again shows that, when the crunch comes, and when faced with the equivalent—this is what we must and will prevent—of the right hon. Member for Leeds, East (Mr. Healey) charging about the Treasury again cutting everything to ribbons, the hon. Gentleman will not be there on the night.

Sir Anthony Grant: I wish to refer to the Labour party's record—my right hon. Friend will recall that the hon.

Member for Livingston (Mr. Cook) was too nervous to give way to me in his speech on this point. Whatever the figures were, is my right hon. Friend aware that, in the last year of the Labour Government, at the famous Addenbrooke's hospital in my constituency, wards were closed, cancer operations had to be postponed, surgeons' records were taken over by militant trade unionists and many poor people were deprived of the services that they wanted by the behaviour of the Labour Government's supporters?

Mr. Waldegrave: The Labour party talks about a two-tier service, but when it left office, the Confederation of Health Service Employees and the National Union of Public Employees were deciding what was an emergency admission.
The truth is that no serious commentator outside believes—I have quoted Professor Julian Le Grand to the House before and I shall quote him again because he is such an objective commentator on these matters—that Labour would be able to do better than we have done on overall resources for health. That argument, as one of my hon. Friends said earlier during Question Time today, is dead. It is unlikely that the 3·5 per cent. growth which we have achieved would be bettered by the Labour party. It has never been bettered in the past.
As Peter Kellner—not a commentator friendly to my party—recently warned, the Labour party should be steered away from the reef of criticising our health spending record because, he thought, our spending had kept up with GDP. I can tell Peter Kellner that we have done better than that. The share of GDP spent on the NHS in the United Kingdom in 1978–79 was 4·7 per cent. It is now, in 1991, 5·7 per cent.—a full percentage point increase. We are spending on health a bigger share of a bigger national product than ever Labour would or could.

Mr. Christopher Gill: Is the essential point not how much the Government spend, which is a lot more than it ever was, nor how much the Opposition promise that they will spend, but how that money is managed? Will my right hon. Friend take this opportunity to tell the Opposition that there is not one patient who cannot see a doctor or who, having been to see a doctor, has not received the drugs that he requires, and that there is not one person who, having been to hospital, has not been entirely satisfied with his treatment, service and attention?

Mr. Waldegrave: My hon. Friend is right. As there is no real argument between us on resources, we then have to concentrate on how best to get the money to the patients, and that is what I shall deal with in the latter part of my speech.
It was only because I was a little surprised that the British Medical Association seemed not to have remembered the Labour party's dreadful spending record on health that I delivered a mild rebuke to it for appearing to join in the party political debate somewhat in favour of the Opposition last week. It would have been an odd alliance, since Bevan—whose great biographer, the right hon. Member for Blaenau Gwent (Mr. Foot), is with us—described the BMA as "an organised sabotage" and "a squalid political conspiracy". Barbara Castle, in her characteristically more moderate language, said that there was
a lovelessness about that bunch that made me sick.


Luckily, since then, the BMA has made it clear that nothing it said was to be taken as any kind of alliance with the Labour party; it was just inadvertent that it gave its press conference the day before the local elections. Therefore, that matter can be laid to rest. There is no contest on funding. As my hon. Friend the Member for Ludlow (Mr. Gill) rightly said, the argument is about how the money is spent. For a party which is not able to commit itself to an overall increase in terms resources for health, Labour has made some extremely dangerous and irresponsible spending pledges.
For example, I calculate that at least £175 million will be needed for the minimum wage pledge, and that may be on the low side. It will be £175 million only if Labour can restrain other trade unionists from maintaining differentials and many—for example, the electricians—have made it clear that that is not on.
As no real increase will come from Labour, that £175 million will have to come from patient care—it amounts to the annual revenues of about six district hospitals. As my right hon. Friend the Prime Minister said at Question Time, Labour is choosing to throw away about £150 million-worth of savings by doing away with competitive tendering, which amounts to the annual revenues of about another five district hospitals, making 11 in total. That is what happens if one says yes to every lobby before one has secured the resources with which to pay for the pledges.
There is a long list—one might call it the nods and winks list—of all the things that Labour has said that it would do when any lobby has come to see them, although it has been careful not to cost them. That long list of things will produce cuts in patient care or it will mean that a large number of disgruntled lobbies will find that Labour's pledges meant nothing. The latter is the likeliest outcome.
Against that background of no more money, we must work out how we can get the money to where patients need it. In the past week or so, another element has been added by the Labour party, which says that not only will money go out of patient care to pay for its friends in COHSE, NUPE and the rest but it will take money out of the pockets of most of the professionals in the health service.
I am not sure whether Opposition Members are aware of this fact. We have dramatically increased doctors' and nurses' pay, as well as increasing their numbers. Instead of cutting their pay, as Labour did, we have put a considerable number of nurses into tax and national insurance brackets in which they would lose cash under Labour's proposals. Every GP and virtually every qualified doctor would lose considerable amounts. On the national insurance change alone, a top consultant would lose about £7,000 plus many thousands of pounds—

Mr. Robin Cook: With a merit award.

Mr. Waldegrave: On a merit award. I was talking about a top consultant. The tax proposals would lose the consultant many thousands more.

Mr. Tony Marlow: rose—

Mr. Waldegrave: I shall complete these remarks and then give way to my hon. Friend.
Therefore, the hon. Member for Livingston owes professionals in the health service a further commitment, which he will not be able to fund. Is he going to make good

their pre-tax pay to make up for the money which his hon. Friends will take out of the pockets of those professionals? That is what he is saying to them. Virtually all senior professionals in the health service will lose money under the Labour party's proposals.

Mr. James Couchman: My right hon. Friend mentioned the fact that doctors will suffer under the proposals that Labour has revealed in the past week. Is he aware also that grade H and I ward sisters, who are towards the top end of the scale in London, will lose, because they earn between £20,000 and £22,000 a year?

Mr. Waldegrave: My hon. Friend is absolutely right. Those nurses deserve that money, and I am proud that I am part of the Government who have begun to put nurses' pay on a proper and reasonable footing. I shall return to the subject of the real cuts that the Labour party made in nurses' pay during its last period in power.

Mr. Ronnie Campbell: rose—

Mr. Waldegrave: I shall give the hon. Gentleman the information, as he seems impatient for it. Nurses' pay was cut by 21 per cent. and doctors' pay by 14 per cent. under Labour. Not only do they face the prospect of further cuts in their real pay, as that was delivered by the last Labour Government, but under the "caring party", on that lower pay they will lose large sums of money in national insurance and tax which the hon. Member for Livingston is signally failing to promise to replace by increasing their pay.

Mr. Ronnie Campbell: The Minister will be aware that the Northumberland ambulance service is now a trust. Is he further aware that the chief executive of that trust—

Mr. Dennis Skinner: What, the spiv?

Mr. Campbell: Yes, the spiv and the personnel manager have given themselves 40 and 60 per cent. increases in their wages.

Mr. Waldegrave: If the management of that service deliver better patient care to the people of the neighbourhood by having more paramedics, which is what they will do, and by having better services, they will have earned that pay.
We see clearly the usual argument from Labour; it wants to get it across to the public that everything will be paid for by "the rich". When we come down to it, who are "the rich"? They are the senior staff nurses and the doctors who have just qualified. Those are the people whom Labour will hit.
The argument is not, therefore, about the overall spending of money; it is about the deployment of money. It has been easy for me to demonstrate in recent weeks that Labour has nothing to say about how to reform the systems in the health service for spending money to get services to patients better. Labour has set itself apart from modern thinking in all western European and other countries about the development and management of public services.
Throughout the western world—not just in Britain—people are seeking new ways of devolving management; that is what the NHS trusts are about. They are seeking new ways of getting cost comparisons and incentives for efficiency; that is what the whole internal market is about. Nothing in the health service is costed in the way that it


will be in future. Nobody knows how best to apply the money. Labour is against that. Finally, it is against providing real power to those who will use it most directly for patients and not for the defence of vested interests. Labour is simply defending the system which was designed in the late 1940s. It is defending vested interests and it has nothing to say on how to develop our great service for the future.
The Independent got it exactly right. It wrote:
Although theoretically the British public loves the NHS we all know that it has been run too much for the benefit of producers rather than consumers and too frequently cannot deliver a decent quality of service. By introducing some elements of the market into the system the Government's reform will apply real tangible pressure for greater efficiency. Labour's own ideas for reform are essentially cosmetic.
That is exactly right.
More brutally, The Times put it as follows:
The fear must be that in demolishing the new system Labour would be handing the service back to the tender mercies of NUPE, NALGO and the BMA.
So little to say—

Mr. Nigel Spearing: Leaving aside the proper interests of collective bargaining, is the right hon. Gentleman trying to say that the health service has been run for the benefit of the doctors, the nurses, the secretaries and the people who work in the service, who are notoriously underpaid? That is what he just tried to say.

Mr. Waldegrave: The hon. Gentleman knows exactly what I am saying. He knows that I believe that the service should be run for the benefit of patients and that those who simply represent the interests of the collective within it are not serving the best interests of the patients. It is that kind of argument which has led to putting off, for year after year after year, the decisions that have to be taken in London and that should be taken for the benefit of the health service throughout the country.
Labour has nothing to say itself on how to reform the structure and to make the systems more efficient. Therefore, I find myself in the happy position of defending a radical and forward-looking reform, aimed at revitalising a great public service, while Labour is left behind, carping, criticising and doing its best simply to scare people.

Mr. Marlow: On the point about scaring people, the way that the Labour party has been behaving over the past few months is reprehensible—[Interruption.] Yes, the Labour party is picking on those who understand these things least and who are most vulnerable. It is reprehensible.
I do not know whether my right hon. Friend has visited Monmouth during the by-election, but a pamphlet is being stuck through people's letter-boxes saying that the Labour party will prevent the local hospital from opting out of the national health service. As I understand it, if a hospital becomes a hospital management trust, it stays four square within the NHS. Will my right hon. Friend make that clear to the hon. Member for Livingston (Mr. Cook) so that he can get in touch with people at the printing presses tonight to put out another leaflet to let the people of Monmouth know what the reality is?

Mr. Waldegrave: Any such leaflet would be disgraceful and would contain a lie. There is no opting out of the NHS, and anybody who issues leaflets suggesting the contrary is simply misleading the public.

Mrs. Margaret Ewing: Will the right hon. Gentleman give way?

Mr. Waldegrave: No, I have given way enough.
I want to deal now with the two main points of carping that Labour, left in our wake, has undertaken in the past two weeks. The first relates to general practitioner fund holding. We believe in giving more power to general practitioners. That is why we started the fund-holding experiment, which put general practitioners in charge of how NHS money is spent for their patients.
On this issue, the Labour party—not uncharacteristically for that party, although it is a little more characteristic of the Liberal party—is facing in two exactly contradictory directions. On the one hand, the Labour party says that it is opposed to the principle of fund holding, on the grounds that it creates what Labour calls a two-tier system. On the other hand, the Labour party is in favour of allowing non-fund-holding GPs to make greater use of extra-contractual referrals—a facility that makes it easier for GPs to shop around to secure the best treatment for their patients. In other words, the Labour party is in favour of fund holding in one case but against it in another. That is typical.

Mr. Ronnie Campbell: Will the right hon. Gentleman give way?

Mr. Waldegrave: No. We have had enough contributions from the hon. Gentleman on this occasion.
How is it that the freedoms exercised by a fund-holding GP are devices, while the freedoms exercised by a non-fund-holding GP using his extra-contractual referrals are not? On this matter, the Labour party needs to get its thinking straight. Does it, or does it not, want GPs to have greater clout on behalf of their patients? I do. I want GPs in the NHS to have the same sort of clout on behalf of their patients as do those looking after people who can afford to go for private health care.
Many of Labour's supporters are clear about what they want to see. Let me quote, for example, Dr. David Colin Thome, who stood as the Labour parliamentary candidate in Warrington, South in the 1983 election:
The reason I find fund-holding attractive is not purchasing, although that is important. I am really excited because it will make us a better provider by reskilling us in clinical medicine and by developing a concept of one-stop medicine. Instead of saying that we want the best deals from hospitals, we shall soon be asking why we need to refer to the hospital in the first place.
Many of Labour's most knowledgeable supporters know that Labour has got it wrong on GP fund holding. In a New Statesman interview, on 22 March, Julian Le Grand called on Labour to give fund holding more of a run. He said:
There are many, including some politically unsympathetic to the present Government, who are excited by the idea, for they see it as an opportunity not only to obtain more control over other parts of the health system, but also to gain freedom to try out many of their less conventional ideas that the NHS bureaucracy has previously stifled.
Exactly.
How long will it take the Labour party to recognise that it is wrong? It said, first of all, that no one would be interested in the scheme. Already, we have 1,700 general practitioners involved. Then Labour said that there would be great problems because the budgets would be insufficient. Now it has had to abandon that case. We have 7·5 per cent. of the population covered, with perfectly


adequate budgets. The Labour party was wrong about that, as it was wrong about the GP contract. It was wrong also about the selective lists. Once again it was simply acting on behalf of any passing lobby that happened to write to it—in that case, the drug companies. On the question of GP fund holding, the Labour party said that there would be no benefit to patients. It said that GPs would not take on difficult patients, that patients would not like it.
On every count, the Labour party has been wrong, so now it has shifted its ground. Patients are benefiting, and the scheme is working, so the criticism has changed. The criticism now is not that the system will not work but that it does work. That is the new criticism. The experiment works very well, bringing immediate benefits to patients, so Labour is against it. When patients benefit, Labour's reaction is, "How dreadful. We must certainly stop that at once. We cannot have anybody getting better treatment."
My reaction is exactly the opposite. My question is, how can we spread this to all the other patients in the NHS? At the end of his speech, the hon. Member for Livingston offered some high rhetoric about the moral divide between our parties. What I have just said illustrates exactly the divide between our parties. We want innovation, with a view to providing better treatment for patients and spreading it to all patients; the Labour party wants to stop any innovation, lest it should work.

Mr. Robin Cook: Let us be quite clear about what the Secretary of State is saying with reference to the way in which the GP fund holding practices are working. He will recall that, last week, the Prime Minister said that patients would be admitted only on the basis of clinical priority. Is he, a week later, saying that it is acceptable to the Government that there should be a two-tier waiting list, that priority should not simply be clinical but should depend on the GP from whom the patient comes?

Mr. Waldegrave: I do not know how the hon. Gentleman thinks the present system works. There is a variety of different waiting lists at present. The hon. Gentleman referred to a case in Watford. Now, a hospital will say, "Of course, we cannot ask our clinicians to do anything they do not believe is right, so we must improve our own standards." An admission limit of a week has been set for urgent cases. That is exactly how the system should work.

Mr. Cook: What the Secretary of State just said contains an extremely clear and very important qualification. Urgent cases constitute a minority of all elective cases. Does the Prime Minister's commitment that admissions should be on the basis of clinical priority apply to all elective cases, including the great majority, which are, as the Government described then, non-urgent?

Mr. Waldegrave: It may be that the hon. Gentleman still does not understand that we are talking about bringing into use facilities not being used at present, without damaging the interests of any patient, and bringing forward treatment for other NHS patients. If the hon. Gentleman is against that, he is against progress. But that would not surprise me.
In this week's General Practitioner, a general practitioner—Dr. Hawkes—says:

The argument that you have to stop improvements could be used against any pilot scheme.
Dr. Hawkes is quite right. We used to be urged to cross the Floor and have experiments on everything. If experiments work, are we to be told that we must stop them? Dr. Hawkes continues:
If we have proved the scheme valuable, any changes will be available to second-wave fund-holders. Any changes seen to be beneficial, especially if they are good value, could be copied by the DHAs, who will be under more pressure from non-fund-holders to do so. We will be running our own waiting-list initiatives, with money which will be divided proportionally between purchasers. We will be hiring local cottage hospital theatres, employing a surgeon and an anaesthetist to reduce the general and orthopaedic surgery waiting lists. Since this will be done using marginal costs, the scheme will be highly cost-effective, and there is no reason why the DHA purchasers should not do the same and benefit all our patients.
Exactly. That is what the people who are actually doing the job say, and it is the truth.
The second matter about which there is much carping is trusts. In the last few weeks, I have heard nothing from the hon. Member for Livingston, or anybody else, to shake my belief that devolving the management to the hospitals is the right thing to do, and we shall continue to do it. The New Statesman has already pointed out to the hon. Gentleman what it calls the weakness of Labour's case. It discusses the mismatch of hospital services in London—how, often, there is not enough community care, not enough local services provided in London, and too many specialties, with people being brought too far. That is the real issue in London. The weakness of Labour's case, as the New Statesman points out, is that this has nothing to do with costs. This situation has existed for 50 or 100 years. It applies to trust hospitals and to non-trust hospitals.
Everyone with the slightest knowledge of the NHS knows that we cannot, for ever and in every hospital, have larger and larger numbers of people. The medical services must be made available where people now live. As I said at Question Time today, it will take skilful management to readjust services and, above all, teaching and research, to take account of where the population now live. But that is not an impossible task. Better management will mean redoubled efforts to avoid end-of-year crises, to have money spent on patients. It may involve looking at labour costs. That would be quite right. It is patient care that matters—not employment patterns in the historic mode.
Even in this respect, the Labour party's campaign has failed. I have had a look at the reports of some recent monitoring. The hon. Member for Livingston talked about the terrible scandal of all these trusts laying off people left and right. As a matter of fact, there are 100,000 people working in the first 57 trusts. The total planned reduction in staff is about 200 net, so I am afraid that the hon. Gentleman's fox does not run. Those are the outline plans; they are tentative plans at the beginning of the process, just as the reductions in labour are tentative plans at the beginning, when they may be necessary. They show that many trusts are expanding and some are contracting. That is surely right in the health service, which needs to change its shape and design to meet the new needs of the people.
Therefore, the great scare that trusts automatically mean redundancies is a non-runner. I hope that the trusts, including those in Bradford, will carefully examine their labour costs because there is no reason for them to employ


more people than they need if they can get the money to patients more efficiently with fewer and probably better paid and better trained people.

Mr. Max Madden: rose—

Mr. Waldegrave: I shall not give way. We must move on, as it is 4.50 pm. I have already debated Bradford issues with the hon. Gentleman many times. He keeps saying that there have been 300 redundancies in Bradford, but he is wrong.
Another attack by the Labour party was on the contracting process. That is a bit thick, because Labour's line of attack on contracting is that there will be less choice—as if there was ever a Labour party interested in choice. We know from history—we have already been reminded today—what choice people had in the national health service when Labour was running it in the winter of 1978–79, when those attractive fellows were picketing hospitals and Labour was not taking decisions about clinical priority because the people who funded the Labour party were doing such things.
The hon. Member for Bradford, West says that there will be less choice, but that shows that he does not understand the contracting system. The system starts by measuring where referrals went in the past. There are discussions with general practioners who cover to the best of their ability—which will increase every year—contracts which follow the flow of patients which GPs defined in the past. If the GPs cannot fully cover that, they have the mechanism of extra-contractual referrals to deal with any further referrals which do not fall within their contracting. They will have enough money to do that, and that is how the system works.
The real purpose of contracting is that, for the first time, we have a mechanism whereby we can deliver health strategies locally and nationally. Those strategies will be worth debating in the House, unlike previously, when priorities could be set but there was no way of defining what would happen. For the first time, there will be public health authorities making agreements with hospitals, enforcing those agreements and measuring the quality, as in the Guy's and Lewisham trust where there has been access to medical audits to ensure that it is doing what it agreed with its district that it would do.

Mr. Madden: rose—

Mr. Waldegrave: By its attack, Labour wants to stop the gains—at least, I am sure that the hon. Member for Bradford, West does—to people from fund holding rather than spreading them to the rest of the people, which is my aim. Labour wants to return hospital management to distant bureaucrats and, for good measure, to put it under the control of regionally elected authorities—that would be wonderful for hospital efficiency. Labour also wants to abandon the health contracting system which, at last, can provide an open way of setting and achieving local health priorities.
There is nothing worth detaining the House in any of those criticisms. As Professor Rudolph Klein wrote in the British Medical Journal this week:
Much of the reaction to the NHS reforms therefore tells us nothing for good or bad except that resistance to change is as inevitable as it is predictable.
Meanwhile, I am happy to say that the NHS goes on not only building the new system but delivering improved health care.
I am happy to give the House and the hon. Member for Bradford, West the latest figures for infant mortality. Infant deaths in 1979 were 12·8 per 1,000 births. In 1989, the figure was 8·4 per 1,000 births and the latest figure for 1990, which I can announce today, is 7·9 per 1,000 births, which represents a further significant drop. The figures for perinatal fatality were 14·7 per 1,000 in 1979, 8·3 per 1,000 in 1989 and 8·1 per 1,000 in 1990—steady and useful progress.
I refer also to the work carried out yesterday by my hon. Friend the Minister of State on one of the most difficult and thorny of all problems facing the management of the health service—the problem of junior doctors' hours. I pay tribute to Stephen Hunter, the junior doctors' leader, and to Professor Margaret Turner-Warwick for the progress which is now being made steadily to produce a sensible resolution to the problem. I also pay tribute to my hon. Friend the Minister of State for the way in which she has helped to guide the discussions.
Last month, we announced the first research and development strategy for the health service. Under the sound and fury of all the nonsense of party politics about the poor old health service, there is co-operation with the general medical services committee on GP contracts, with the General Dental Council on dental contracts and with the joint consultants committee on a variety of issues.Work is being done in the regions by the deans to prepare—quite rightly—for the changes that will be needed in London. It is right that those changes should be made—let us listen to the words of Professor Rubin of the Queens medical centre in Nottingham. He wrote to The Independent on 13 May:
Since its inception, this prestigious provincial teaching hospital"—
he meant the Nottingham medical centre at the University hospital—
has looked after more patients with less staff than London teaching hospitals and has avoided moving into debt. Do you suggest that our prize should now be to see profligacy or inefficiency elsewhere rewarded by cash injections? Surely not.
One of the greatest achievements"—
we should note that all the consultants signed the letter—
of the original NHS was to produce a more even distribution of high quality health care around the UK, but it never went far enough, with London in particular keeping its doctors which the patients moved away. A laudible aim of the new NHS is to put money where the patients are and thereby redress still further the imbalance. This will be painful. However, pouring money into hospitals that have lost their patient base would be a triumph of short-term expediency over common sense.
That is exactly what the Opposition stand for—short-term expediency over common sense.
The issues must be tackled—efficiency, the London issue, junior doctors and all the others. The test of commitment to the NHS is not whether one can shout as loudly as the hon. Member for Bradford, West but whether one tackles the underlying issues. We have heard nothing from Labout today about any of those issues. By the ruthless and irresponsible use of scare stories, Labour tries to hide its nakedness over resources and its bankruptcy on policy. The real argument is being won by the Government and I urge the House to support our amendment.

Mr. Michael Foot: Owing to my longevity and the constituency that I have the honour to represent, I think that I have had more exchanges with medical experts than any other hon. Member, and some of those exchanges have been of a personal character.
One of the Secretary of State's mistakes—it is difficult to select one from all the others—is that he does not take account of how the Government, in preparing their proposals, would not listen to those in the profession, whether they were the British Medical Association, the royal colleges, the nurses or the trade unions. Everyone involved in the national health service was told that they would have to wait until much later, but much later they were told that they could not have a meeting with the Prime Minister. One of the reasons why the Government are in such trouble is that they have not listened to any of the people who knew about the service.
When the proposals were first introduced, I remember going to see a consultant—I shall not say what extremity of my body he was dealing with, but I can assure the House that they are all working at the moment. I shall not identify the consultant, because I do not know how the Government would deal with him. When the proposals were made, he said that he hoped that the Government would not let British management loose on the national health service because that would be the coup de grace. Now, the same expert says that it is Mardi Gras for the accountants. That is what some of the people on the spot think of it. If the right hon. Gentleman had listened carefully to all the representations, he would have had a few different ideas.
When I had another operation, it took four hours to perform. Under the present proposals, that would be chalked up against the hospital and, no doubt, chalked up against the expert, Mr. D'Abreu from Birmingham. He happens to be the greatest expert on that subject. I should be interested in what he has to say about the Government's proposals for speeding up the operations process as one of the ways of testing what can be done.
As for what has happened to the physiotherapists, I daresay the right hon. Gentleman will produce statistics to show that there has been an increase in the number of physiotherapists. Nevertheless, I should question any statistics that he may produce. My hon. Friend the Member for Livingston (Mr. Cook) exploded a great many of those statistics in his speech. I have been very suspicious of the Government's statistics ever since the right hon. Member for Chingford (Mr. Tebbit) first got his hands upon them. I have never believed anything that the Government have had to say since then.
Anyone who talks to physiotherapists will be told what is happening. In one way or another, the number of physiotherapists in hospitals has had to be curbed. Anyone who knows anything about it knows that physiotherapists are one of the keys to providing an essential form of preventive medicine. The better the facilities for physiotherapists, the less we may have to spend on other services.
I remember a classic illustration when I was writing about the part that Aneurin Bevan played in the creation of the national health service. I went to see some of the doctors who had been most bitterly opposed to its introduction. I say this in particular to the Secretary of State, in view of his remarks today about the British

Medical Association. It is true that Aneurin Bevan had arguments with the BMA, but he dealt with the whole question a good deal more sensibly than the present Government. He listened to the arguments. He also had plenty of meetings with the leaders of all the royal colleges—the very people in whose faces the door was slammed by the right hon. Gentleman's predecessor and the Prime Minister only a year or two ago. What happened illustrates a central feature of the NHS that the right hon. Gentleman and his right hon. and hon. Friends have never been able to understand.
One of those whom I went to see in 1960, soon after Aneurin Bevan's death, in order to discover what the BMA had to say about the arguments, was Dr. Roland Cockshut. He was one of those who had led the campaign against Aneurin Bevan and the establishment of the NHS. He said that we should not have a national health service and he denounced Aneurin Bevan for the way it was introduced, but when I went to see him in 1960, just after Aneurin Bevan's death, it was a different story. He said, "We didn't understand what the reality of the service was going to be; we were astounded—I am now talking as a general practitioner—to discover how wonderful it was to have introduced into our service the principle that we didn't have to care whether a person could afford to pay or not." He went on to say to me, "It was such a revelation—of course. I should have understood before. This principle is not only wonderful for patients; it is a liberation for every decent doctor in the land."
That is what the national health service was about. That is why the BMA's attitude changed—and all honour to it. It has fought persistently against what the right hon. Gentleman and his right hon. and hon. Friends have introduced. If they had had the sense to look more carefully at these matters, they might have avoided the whole of this terrible catastrophe that has befallen their Government—second only to the poll tax catastrophe. It is difficult to say which is worse. It is a tender balance.
This catastrophe for the Government goes back to the crucial decision made by the former Prime Minister, who decided to have a so-called reform of the national health service. She could not bear the idea of the continuance of a service that had as its central principle the socialist principle that no money should be charged and no market principle should dictate what was to happen to patients.
The former Prime Minister was so obsessed with opposing that principle that she would not even appoint a royal commission, or consult the royal colleges, or have conversations with any of the people working in the national health service—the trade unions, the British Medical Association, or anybody else. She said, "We are going to do it ourselves", so she set up a committee. If someone on the committee was not prepared to follow her—I am sure that the right hon. Member for Old Bexley and Sidcup (Mr. Heath) would confirm what I say, as would anybody else who has followed the details of these matters—they knew exactly what would happen. Never before had there been the proposition that a major institution in this country should be overhauled by such a method.
The former Prime Minister produced for that committee plans that have now come to fruition in an Act of Parliament. However, it had to be forced through the House of Commons by means of the guillotine. It was forced through without taking into account the protests of


the few Conservative Members who had the courage to stand up against it. Worst of all, and most despicable of all, it had to be forced through the Cabinet.
One would have thought that a few members of the Cabinet—the present Secretary of State for Health at least has the distinction of not having been a member of that Cabinet, and if I were he I should continue to insist on that claim—would have stood up to the former Prime Minister. Some of the members of the Cabinet resigned on other issues, but not one of them dared to resign either over the poll tax or over the measures that were being taken to deal with the national health service. Not one member of that Cabinet of creeps dared to protest. That is why we are faced with this situation today, and most people in this country know it.
The right hon. Gentleman talked about having ballots. People in Monmouth know very well what the arguments are about. They are not being deceived by the Opposition about these matters. The argument is not that the national health service should necessarily be preserved in every detail as it was originally conceived. Nobody said more loudly than Aneurin Bevan that of course it had to be reconsidered every five, 10, 15 or 20 years to see whether it could be made into an even better service, particularly since, as he claimed, the NHS ought to be made into a democratic service. That is very different from the Government appointing managers, at high fees, to carry through any changes that they want.
We have never said that the NHS should remain exactly as it was at the beginning. We have always said, as my hon. Friend the Member for Livingston emphasised—

Mr. Waldegrave: Will the right hon. Gentleman give way?

Mr. Foot: I shall give way in a moment.
My hon. Friend the Member for Livingston properly emphasised the fact that greater resources must be allocated to the NHS. I was very glad to hear him blow out of the water all the false figures about what happened under the last Labour Government. The Government have been peddling those figures throughout the country for six or seven years, so it is good that my hon. Friend blew them out of the water. Even more, I believe that the leadership that he has given both to this House and to the country is a fine promise of what he will achieve when he becomes the new Secretary of State for Health and a fine promise of how we shall sustain the NHS and its original principles.

Mr. Waldegrave: The right hon. Gentleman has talked in his marvellous speech about resignations. Did this poem happen to pass in front of him in the Cabinet in which he served, written by the present Lord Silkin and passed to Barbara Castle:
All things bright and beautiful, All projects great and small, All things wise and wonderful, The Chancellor cuts them all.
At that time it was the right hon. Member for Leeds, East (Mr. Healey).
He cuts the old age pension, Although he cuts by stealth, And while he looks for savings, He cuts the National Health.
I do not think there were any resignations on that occasion.

Mr. Foot: If the right hon. Gentleman wants to learn some history, he should go back further still—

[Interruption.] We now have the Minister learning a thing or two. If only he had listened rather earlier, the Government would not be in such a fix. He has made the great discovery that the Treasury has always been against the NHS, even in 1947–48. The Treasury was against the NHS then and we had a big fight to get the necessary funds. The Treasury has never understood the simple principle in the context of which I quoted Dr. Roland Cockshut. The Treasury has never understood the principle that one could have such a system and that if it was run on decent and humane principles it would not put profit and the market first.
The patient must come first, and that must happen genuinely. To do that genuinely, one cannot say in advance how much the service will cost. We had all those arguments way back, before the present Secretary of State was born or even thought of. The Treasury was against it then, and there must always be good Ministers of Health to stand up to the Treasury. The Labour party has an extremely good one who will take office shortly—as soon as the right hon. Gentleman and the Government dare to take the issue to the public.

Sir Barney Hayhoe: It would not be appropriate for me to follow the right hon. Member for Blaenau Gwent (Mr. Foot) in his historical reminiscences, except to note that he made no response in substance to the interruption, towards the end of his remarks, by the Secretary of State.
Labour's shadow Secretary of State set the tone of the debate in his characteristically knockabout, witty but rather superficial speech. He clearly demonstrated that the debate is more about politics than patients and electioneering than health care.
I remind the House of my declared interest in health care, as set out in the Register of Members' Interests. I confess that I have not been an enthusiastic or uncritical supporter of the Government's reforms of the NHS, but Labour's antics in recent weeks have been so sickening that I am grateful for this opportunity to intervene briefly in the debate. I do so for two reasons—first, to denounce Labour's cynical attempts to exploit and mispresent particular incidents and problems in a destructive and highly partisan fashion; secondly, to express my confidence in, and support for, the Secretary of State and his team of outstanding Ministers.
It will be within the recollection of the House that Labour pounced on the recent news of possible job losses at Guy's with undisguised glee and tried to present it as a general condemnation of the whole concept of trust status hospitals. What absurd nonsense that was, and it was quickly shown to be so by the similar job losses announced for the Charing Cross and Westminster hospitals, which remain under the control of their district health authority.
Another example of Labour Members' deliberate misrepresentation has been their continual use of the phrase "opting out", with its implication that such hospitals are no longer part of the NHS. The hon. Member for Livingston (Mr. Cook) said that a Labour Government would bring hospitals back into the NHS. That is nonsense, because no hospital which goes for trust status leaves the NHS. An hon. Member whom the right


hon. Member for Blaenau Gwent praised as a future able Secretary of State should not misrepresent the situation in such a monstrously outrageous fashion.
I find it appalling that the media give prominence to such phoney propositions, when responsible medical correspondents must know the truth. Labour's spokespersons—among whom I include the hon. Member for Peckham (Ms. Harman)—accuse the Government of planning to privatise or demolish the NHS. Again, what nonsense that is; and how irresponsible and uncaring of Opposition Members to generate groundless anxiety among those who do not recognise how bogus such charges are.
The NHS is a much valued national asset which is, and will remain, a crucial and essential part of the public sector, largely financed from taxation and continuing to provide services free at the point of delivery, the aspect to which the right hon. Member for Blaenau Gwent referred.
As a former Treasury and Health Minister, I congratulate the Secretary of State and the Chief Secretary on the significant real-terms increase in funding agreed for this financial year. Over £3 billion extra represents nearly 50 per cent. of the total amount allocated to the NHS in the last year in office of the last Labour Government.
As one who has long pressed, in and out of government, for additional funding, I should like to see even further increases, not least for capital projects, including much needed work to the West Middlesex University hospital in my constituency, but I recognise the very considerable additional funds that have been agreed in a difficult public expenditure year.
There has been much controversy recently about what Labour might or might not do if—it is a mightly big if—it was returned to office. Fudge and smudge seem to be the order of the day, and the hon. Member for Livingston did not shed any new light on the subject in his long speech. He talked about underfunding but made no promise or pledge of extra funds being made available by an incoming Labour Government. Opposition Members do not quote a figure, and that was significant in all the hoo-hah and shroud-waving from the hon. Member for Livingston.
Not uncharacteristically, the BMA has entered the bidding with demands for what appears to be a speedy and massive increase of between £4 billion and £6 billion—wholly unrealistic figures, as anyone with knowledge of public finance must acknowledge. Interestingly, the BMA—not the doctors' professional organisation but their trade union—which I can remember making quite a fuss about when part of the review body pay award was delayed for a few months, seems to have said nothing about Labour's new tax and national insurance proposals, which could cost senior consultants more than the whole of this year's pay award—presumably permanently and not deferred for a few months. It would certainly reduce take-home pay for the vast majority of BMA members.
No wonder the Leader of the Opposition is being so kind to the BMA in return for the kindness of its leaders, who seem to be behaving in a remarkably partisan fashion—perhaps not wholly deliberately, but at least that is how it appears in public print.
Perhaps it is appropriate to remind the BMA that the only year in which there was a real cut in NHS funding

—I return to the point so clearly made by my right hon. Friend the Secretary of State—was 1977–78, under a Labour Government who also slashed the hospital building programme and remorselessly resisted reasonable pay increases for nurses. We should remember the Labour party's record when we see the nudges, winks and nods on the Opposition Front Bench.
There will always be health problems, whatever the politics or health care system, but there is a marked contrast between Labour's destructive and propaganda approach to those problems and the approach of my right hon. Friend the Secretary of State. My right hon. Friend is dealing with current problems in a sensitive and constructive fashion. For example, he and my right hon. Friend the Prime Minister have responded positively to genuine anxieties. I refer not to the assertions that the Leader of the Opposition made at Question Time, but to genuine anxieties about GP fund holders, who seek preferential arrangements for their patients.
I am glad to note the sensible comments of my right hon. Friend in the House today and in his speech to the Royal College of General Practitioners on 9 May, when he said:
There may well need to be some ground rules agreed about what can and cannot be asked for by a fund holder—or a district for that matter—from a provider. It is our intention to listen, discuss and, where possible, agree.
Many problems need just such an approach, such as medical education, the problem of London hospitals and junior doctors. I congratulate my hon. Friend the Minister for Health for the great progress that she has initiated and with which she is pressing forward on that score.
I hope that the Government will propose positive action for nurse prescribing. All of these and many other problems can be resolved by my right hon. Friend's patient and sensible approach. I shall support him enthusiastically in the Lobby tonight.

Mr. Charles Kennedy: Like the right hon. Member for Brentford and Isleworth (Sir B. Hayhoe), I shall be brief, although he will understand that the similarity between our contributions ends there. I shall speak less about the Labour party's policies than about the Government's present action, approach and philosophy on the national health service.
It strikes me that, as we last debated health issues in the House only a couple of weeks ago, the element of predictability on that occasion has been reinforced today. Hon. Members have mentioned the warnings that were given when the National Health Service and Community Care Bill was rushed through with unseemly haste and with inadequate consultation on the likely cuts. They have spoken of the reductions in services and the fact that doctors' clinical decisions would be overriden. The indifference to community aspirations and to patients' views in particularly localities was bound to be a cauldron of political controversy, and has proved to be so. However, as other hon. Members have remarked, so has the scene of the current by-election in Monmouth.
However one views the Government's position on the fiasco of the poll tax, at least they could find a scapegoat and blame local councils for some of the difficulties encountered with local government finance. The difference on this occasion is that the fault lies entirely with the Government.
During Report stage of the National Health Service and Community Care Bill, my hon. Friend the Member for Southwark and Bermondsey (Mr. Hughes) introduced what the then Secretary of State for Health, the right hon. and learned Member for Rushcliffe (Mr. Clarke), described as a mini-Adjournment debate on Guy's hospital. Many of the problems that he predicted have, unfortunately, come to pass. It was remarkable that, when the controversy about opted-out hospitals—those first flagships—hit the headlines several weeks ago, the Secretary of State suggested that he was unaware of the details of the business plan for the anticipated levels of employment.
If one went to a bank, building society or even a Government enterprise agency seeking support for a business plan and one was unable to tell the person making the decision that, within four weeks, 600 redundancies would be announced, that would be a somewhat deficient business plan. The fact that the Secretary of State did not know the details suggests either that he was not doing his job or that the managers who proposed the business plan were not sufficiently on top of their jobs. That hardly gives one confidence in the business of opting out or in the self-governing status of hospitals.
It is worth considering the management of the health service and what has happened to representatives of local communities. A survey by the British Medical Association, which the right hon. Member for Brentford and Isleworth called the doctors' trade union, showed that, of 410 non-executive members of 82 district health authorities in England and Wales, 51 are doctors and 31 are councillors. By contrast, 164 were chosen for their business and accountancy skills.
I do not say that business and accountancy skills do not have a role to play in a service as massive and complex as the national health service, but when those new appointments are so loaded in favour of those who have no direct representative role for the local community, or personal and professional involvement in health care and its delivery, something has obviously gone wrong. As we saw throughout the country at the local elections, that has caused people to conclude that the national health service is not safe with the Government.
What about the financial viability of the trusts? The management consultants, Coopers and Lybrand, whom the Secretary of State asked to prepare the business plans for the first round of NHS trusts, concluded that only 12 of the 56 so far established were financially secure. The report warned that all but 12 have "considerable financial problems". Is it sensible to send out the boat against such a background? Clearly, London hospitals will be drawn into tighter competition, with uncertain consequences.
The Coopers and Lybrand report concluded:
a number of hospitals could easily find themselves in this position and to some degree it would be a matter of chance which ones would be most seriously affected. It is not obvious that any closures forced would be the most appropriate.
In management consultant terminology, that is as politically clear a statement of anxiety as one is likely to get. We should not leave such questions to "matters of chance".
Moreover, the new management system does not come cheap. So far, £80 million has been spent on advertising and the cumulative costs incurred by the new appointments advertised throughout England and Wales.

In health terms, that £80 million will amount to the equivalent of about 8,000 hip replacements, which is what we have forsworn as a result of the new management.
The opting-out system should stop. The second wave of opting-out hospitals should not go ahead until the Select Committee on Health has taken a further look at the business plans I know that the Select Committee has already done much work on the subject, and I pay tribute to its Chairman, the hon. Member for Macclesfield (Mr. Winterton) who is in the Chamber. The Select Committee is currently considering the business plans, and a report from the Select Committee should be discussed on the Floor of the House before we go another step further.
When the Secretary of State talks about general practitioner budget holding, I notice a curious irony. The hon. Member for Livingston (Mr. Cook) criticised the two tiers developing in the GP budget-holding system, because he said that those doctors with budgets would have a better chance of ensuring that their patients were treated where and how they wanted. I am not sure whether that criticism of the system will be the most telling one.
The political problem with budget holding is that it will prove to be, as it has already been, popular with GPs because of the clinical control that it gives them and, if the name of the game in the new system is that managers with contracts make the decisions, it means that GPs can exercise more medical freedom. As the costs and the squeeze are placed on the free-standing budget holders, Health Ministers will have to go along with the decisions made by the budget holders, because they will not want to undermine management figures who want to control the clinical decision making. That will be the political hot potato with GP budget holders.

Mr. Ian McCartney: Another scenario has proved to be an increasing problem in the north-west: GPs who are not budget holders are excluded from services in their own districts. In my district, the mammograph service was paid for through public funds—£80,000 was raised by a charity. Some GPs who asked women to have a mammograph found that those women were excluded by the district health authority, which had sold its spare capacity of the publicly funded service to other health authorities at a substantially increased cost to gain income for the contract service. The GPs knew about that only when referrals were sent back by the relevant consultants stating that they could not see the women to give them a mammograph.

Mr. Kennedy: I am grateful to the hon. Gentleman, who speaks with a level of knowledge on the matter which I cannot equal. He made his point extremely well. If that is the extent to which professionals in the health service are operating in the dark, it further underlines the anxiety expressed by Opposition Members.
I now turn to the subject of funding—or, as many Opposition Members continue to argue, "underfunding"—in the health service. Earlier, I became confused as to whether we were discussing matters in relation to the financial or the calendar year. In the current year, there is a significant percentage increase in funding. However, this is likely to be an election year, and the projection beyond this year is that the level of increase will dip sharply.
There is a strong case for saying that, in the longer term, the NHS should have more security of funding and should probably enjoy a Government commitment of real annual


growth of 2 per cent. above the inflation rate. I do not think that the spending cycle, in which funding tends to go up as we near polling day and then down as we move further away from an election, promotes stability in either the structure or delivery of services.
The hon. Member for Livingston rightly referred to statistics and information made available to a number of us yesterday and today on what was happening at exactly this moment—5.30 pm—in King's College hospital yesterday. He referred to a couple of examples, and I shall use another one. The individuals brought into that hospital for emergency treatment included: a man aged 80 with chronic obstructive airway disease, who spent five hours on a hospital trolley; a man aged 79 with congested cardiac failure, who spent six hours on a hospital trolley; and a lady, to whom the hon. Member for Livingston referred, who was aged 89 and was both deaf and blind, and spent nine hours on a hospital trolley waiting for treatment. We cannot be sanguine about the state of our national health service when faced with such facts about humans waiting for treatment in this city only 24 hours ago.
I find it unbelievable that one Conservative Member who, characteristically, is no longer present, said that there was no patient with a complaint about hospital treatment anywhere in the country. That hon. Member should talk to any one of the three individuals of which I spoke, or to thousands more like them up and down the land, because he would then realise that they would have no confidence in this Government's handling of the national health service. That verdict will come through clearly on Thursday in Wales and, with even greater resonance, across Scotland, England and Wales, at the next general election.

Dame Jill Knight: I do not think that I would wish the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) to be silent on the problems of the health service, but we would all find it much more interesting if he would come off the fence and give some idea of what the Liberal Democrats intend to do about health matters. Their amendment is pathetic. Many of us would listen to the hon. Member, perhaps not with fervent interest, but with mild interest, if we had some clue what his party thinks should be done, but instead of giving us that information he simply cites cases where something obviously needs to be done.
The very fact that we are debating this ill-informed motion today shows the Labour party's total lack of understanding of the health service and its needs. The Labour party believes that reform is unnecessary, even when we are faced with massive evidence of the crying need for reform. The Labour party wants the health service left as it is. Labour's only answer to deficiencies in the health service, which we are trying to remedy, is that everything will be all right so long as we double, treble, quadruple or multiply by the number we first thought of, the money that we spend on the health service. The Labour party approaches every problem with a closed mind and an open cheque book—albeit with a cheque that is post-dated and

likely to bounce. Labour's attitude towards problems is always to throw money at them unceasingly in the hope that they will be sorted out.
The other night, I had a dream. As is the way with dreams, I was transported, without realising how, to Walworth road. I could hear the banging of hammers and the sawing of wood and I saw that a great arch was being put up over the door of the Labour party headquarters. The words of the motto that the workmen were putting up were, "There is no difficulty that money will not solve—promise any amount." Of course, that is a splendid motto for catching the unwary voter.

Ms. Harriet Harman: Go back to sleep.

Dame Jill Knight: The hon. Lady will be sorry that I am awake.
The beauty of that motto is that the money is not Labour party money, and the beast of the motto is that the theory is a monumental mistake.
There are four excellent reasons why reforms are essential. The first reason is the enormous variations in standards of patient care that exist in the health service. The Labour party has the cheek to talk about a two-tier service developing under the reforms when five minutes research would show that there have been many tiers in the quality of service. The major reason for our reforms was to ensure that all patients, everywhere, receive the same excellent care. The Labour party either does not know or does not bother about a patient being six times more likely to get care in one area than in another, or about someone being three times more likely to get a hip operation if he lives in the south than if he lives on Merseyside. If I represented Merseyside I should be worried about that, but the Labour party does not seem to care.
Some orthopaedic surgeons in the NHS do more operations in a month than others do in six months. Some ear, nose and throat surgeons do 10 operations while others do only one. That cannot be right. Some general practitioners give a far better service than others although they have exactly the same case load—the same number of patients, the same number of the chronically sick, of elderly people, of young people, and so on. There are enormous variations in standards of care. There was always an uneasy feeling that that was the case, and we had studies done that proved it. But the Labour party does not want to know about that. Instead, it has the brass neck to claim that our reforms will bring about precisely what they will remedy. The Labour party could not recognise unfair differences when it saw them, and now it does not recognise effective reforms when they are in front of its nose.
Inefficiency in the running of the health service is a major reason why some patients are denied the treatment that they need. It is no good saying that we should throw more handfuls of money at the problem. We must realise that inefficiency is one of the greatest enemies of patient care in the health service.
The national health service was set up more than 40 years ago for patients who could not get the operations, drugs and other treatment that patients get today, many of which had not even been invented. Modern medicine, like modern business practice, has advanced out of all recognition since 1948. Last week I went into my bank to find that it has reorganised the way one is served, the way one has to wait and the way chequebooks are sent. If it is


essential to bring the high street banks up to date, how much more essential it is to bring up to date and make more efficient the biggest business in Europe.

Mr. Ian Taylor: A £30 billion operation.

Dame Jill Knight: Exactly so.
The second reason for the reforms is the need for more up-to-date management. Some of the most impressive preparation for the reforms has been made by the National Audit Office, and I take this opportunity to pay tribute to the enormous amount of work that it has done in a short time on costings, utilization, property and services. It has used its expertise to provide many examples of improvements that could be made and of money which could be obtained for patient care if only we dragged the whole system kicking and screaming into the second part of the 20th century.

Mr. Ian McCartney: Will the hon. Lady give way?

Dame Jill Knight: No, I am trying to be quick. Other hon. Members wish to speak.
The National Audit Office said that efficient use of operating theatres was the key to reducing waiting lists. It said not that more money should be thrown at the problem, but that operating theatres should be managed more efficiently. Day-care surgery, the use of computers, and proper reviews and checks on waiting lists were also identified as important. It amazes me that the Labour party seems to have no conception of the message sent out loud and clear by the National Audit Office—that the reforms are essential. The enormous imortance of efficient management has nothing to do with simply allocating more money.
The third reason for the reforms has to do —with money with the need to direct funds better and reduce waste.

Mr. McCartney: rose— —

Dame Jill Knight:: No, I shall not give way.

Mr. McCartney: Give way.

Hon. Members: Sit down.

Dame Jill Knight:: The National Audit Office has said that at least 10 per cent. of the land and property owned by the health service was surplus to any possible requirements and that £300 million per year could be saved in that area.
The provision of sterile products and services in hospitals—packs and so on—is not well controlled, according to the National Audit Office, and could be carried out more reasonably and cheaply, resulting in savings. Better use could also be made of energy in the health service. The Government's reforms will cover that aspect, too. The National Audit Office also explained how £100 million per year could be saved by the more efficient use of operating theatres.
What about drugs? Everybody knows that a huge proportion of health service funds is spent on drugs. How much of that is wasted? In Yorkshire there was a campaign to call in medicines not being used. In three weeks 2·5 tonnes were handed in. What a waste of money. It was reported that in Oxfordshire when the relatives of someone who had died cleared out the house they found 4,112 Valium and 807 Mogadon tablets—somebody actually bothered to count them. No doubt the National Audit

Office could tell us in a flash how much that cost the health service, but my complaint is that money was wasted which could have been spent on patients. The Government's reforms will ensure that the money is spent on them.
The Labour party merely says that more money should be spent on the health service, regardless of the fact that, as has been amply illustrated today, the Labour Government cut funding, whereas we are vastly increasing it. The Labour party does not have a leg to stand on. Our tactic is to spend as much money as the country can afford while ensuring that every pound and every penny is wisely spent and not wasted. All the savings will go straight back into patient care.

Mr. McCartney:: Will the hon. Lady give way?

Dame Jill Knight:: I have not the slightest intention of giving way. The hon. Member for Makerfield (Mr. McCartney) can save his time and his voice—and mine, too.

Mr. McCartney:: Start talking some sense, then.

Dame Jill Knight: Every word that I am saying is true, provable and relevant to the debate. I shall not take lessons from the hon. Gentleman, who has not been in the House for more than five minutes—[Interruption.]

Mr. Deputy Speaker (Mr. Harold Walker):: Order. The hon. Member for Makerfield (Mr. McCartney) must not seek to intervene from a sedentary position.

Mr. McCartney:: I was standing up, Mr. Deputy Speaker.

Dame Jill Knight:: The Labour party never says a word about ending waste—it merely castigates us when we try to do so.
The fourth and final reason for the reforms is the need to shift decision-making closer to those who best know their own situation. In campaigning to prevent hospitals from managing their own affairs, and GPs from deciding on their own expenditure, the Labour party is saying that hospital boards are not capable of making their own decisions, and that GPs are not intelligent enough to manage their own budgets. Labour can go to the country on that sort of cry if it likes, but it will not hold up. Local hospitals are far more capable of managing their own affairs.
Time and again in my political and private life, in local Government and in the House, I have seen examples which prove that those closest to the centre of any organisation are infinitely better at deciding how money should be spent and what decisions should be made in that organisation. Labour denies that, and that has something to do with its fixation that the man in Whitehall knows best and that nobody has enough sense to manage their own affairs. Perhaps Labour also clings to the belief that everything and everyone—doctors, hospitals, schools, businesses or people—should always be subject to outside control.
We forgive Labour its fixation and its outmoded beliefs, but we cannot forgive its deliberate misrepresentation that trust hospitals are opting out of the national health service. The Opposition know that that is untrue, but they keep trying to perpetuate the lie. The fact that they do not perpetuate it in today's motion is no reason for not pouring scorn and condemnation on it, as I certainly do, and no reason not to vote against it with derision.

Mr. Brian Sedgemore: I should like to make two brief points. First, on Thursday at Prime Minister's Question Time, the Prime Minister spent much time quoting with approbation the words of Dr. Ken Grant about the national health service reforms. Judging by the resounding cheers from Tory Back Benchers, Dr. Grant could be the wisest guru on medical matters who has ever been born. I know rather more about Dr. Ken Grant than the Prime Minister and all the Tory Back Benchers put together. Dr. Grant might even be a friend of mine.
I was particularly surprised to hear the Prime Minister say that Dr. Grant had said that setting up an NHS trust was opting out of bureaucracy because Dr. Grant is probably the last person on earth to make such a remark. My friend Ken Grant is not a practising GP; nor does he work in a hospital as a doctor. He is a wheeling-dealing, fixing bureaucrat who, over the past three or four years has created, ordered, arranged, set up and established all the bureaucracy in the City and Hackney district health authority. All its successes are down to him, and all his criticisms, which the Prime Minister quoted so eagerly, are an indictment of himself.
What does my friend Ken intend to do now? He plans to leave the district health authority to set up a new bureaucracy, so that we shall have two bureaucracies instead of one. We shall have the district health authority and the hospital trust, which in this case will run not one hospital but several, and all the facilities of the district health authority. The Prime Minister says that that is good, but I remind the House that the last time the Conservatives reorganised the national health service, it led to an enormous increase in the number of bureaucrats. It is a racing certainty that this reorganisation of the health service will lead to bureaucrats multiplying like loaves and fishes in Judaea. We shall have more bureaucrats and fewer doctors and nurses.
About two weeks ago, I was drinking champagne in the great hall of Gray's Inn in celebration of the fact that my former pupil, Helena Kennedy, had become a QC. Over the champagne, I had an argument with Ken Grant about the NHS reforms. I put my arm around his shoulder and said, "Tell me, Ken, what is it in this life that you really believe in?" He said, "They keep changing the ground rules and that makes it difficult for me. I spend too much of my time emptying beds and closing wards to reduce our deficit." I said, "Why don't you fight for what you think is right?" He gave me a quizzical look, as if to say, "Only a politician would be stupid enough to make a suggestion like that."
When Ken dies, he will almost certainly go to hell, but, quite undeterred, he will immediately set up a consortium of the helpless, the hopeless and the hapless—as he has done with this national health service trust application —and he will start negotiating with the devil. I say to him, "Ken, don't do it. Why sup with the devil on that side of the House when you can walk with God on this side?"
The hon. Member for Birmingham, Edgbaston (Dame J. Knight) spoke about a dream. My second point is about the shattering of a 17-year-old dream about the building of a new district health authority hospital in Hackney. That dream started under the last Labour Government and a few years ago, half of that hospital at Homerton was built. But half a hospital is not enough, and it looks a bit odd.

Just a year ago, the regional health authority said that we could have the other half because it had the funds and the date, and the Government had cleared the scheme. Four weeks ago, the regional health authority, backed by the Government, said that phase 2 of the Homerton hospital will not be built—today, tomorrow or ever.
We went to see a Minister about the hospital. He gave us lots of sympathy and a cup of coffee, but insisted that the money for phase 2 was not available. The mind-boggling reason given to us for not building phase 2 of a hospital first thought about 17 years ago was that the property market was such that funds would never be available.
On Thursday, the Prime Minister said that the NHS would deal with its problems on the basis of clinical need. There is much discussion about who has or has not O-levels and about who is or is not educated. It is preposterous to suggest that clinical need has something to do with the current state of the property market. Clinical need has no more to do with that than it has to do with the position of Jupiter or with the fact that the remains of the mad axeman are embedded in the concrete of the M4. That is an absurd reason for not building the second half of a hospital.
We have decided to put up a plaque on our half-hospital, giving the names of the five guilty people. They are William Waldegrave, Tory; Tim Chessels, chairman, regional health authority, Tory; Virginia Bottomley, Tory; Evan Stone, chairman, district health authority, Tory; and Stephen Dorrell, Tory. That should explain why we shall be voting against the Government.

Mr. Nicholas Winterton: The hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) spoke about Dr. Ken Grant supping with the devil, and suggested that he should instead sup with God. Dr. Grant has supped with the select, in so far as he has been a distinguished adviser to the Select Committee on Social Services, the predecessor of the Select Committee on Health. As a specialist adviser, Dr. Grant contributed to a report by the Select Committee on Social Services and, in general, that report was warmly welcomed by the Opposition. Perhaps Dr. Grant has rather more ability and talent than the hon. Gentleman gave him credit for. Many of us who worked closely with Dr. Grant for a long time know that he is a distinguished and qualified community physician. He has the qualifications and the necessary skill to do the job that he is currently undertaking.

Mr. McCartney: I agree that Dr. Grant advised the Select Committee, but the hon. Gentleman should remind the House why the Opposition welcomed the Committee's report. It was because it recommended that the Government should not go ahead with trust opt-out hospitals until a pilot scheme had been conducted. The Government rejected Dr. Grant's advice, although it was accepted by the Select Committee.

Mr. Winterton: I am grateful to the hon. Gentleman for reminding the House of some of the conclusions and recommendations set out in the Select Committee's report, which I stand by to this day.
Today, the members of the Select Committee on Health visited the Bessborough clinic in the Riverside health


authority here in Westminster. We also visited the West London hospital and the Queen Charlotte maternity hospital. It is important to say from the Government side of the House that there is concern among those working in the health service and those who come to it for treatment about the Government's reforms. Most of those we met today—managers, midwives, nurses, doctors and consultants—accept that the reforms are with us and that we must make them work.
I give my right hon. Friend the Secretary of State due credit for saying that, if some adjustment needs to take place or some amendment needs to be made to the reforms, he will ensure that it takes place. I know from my experience in dealing with trust applications that, if there is concern about whether applications should be put back for further consideration, my right hon. Friend is prepared to take that course so that the concern that is felt in an area in which applications are being submitted can be reconsidered and examined in the calm light of day.
It is important that the House should know that the Select Committee on Health—we have had full co-operation from my right hon. Friend the Secretary of State—will take evidence on the morning of Wednesday 22 May from Guy's and Lewisham health service trust and from the Bradford health service trust. The chief executive and the chairman of Guy's and Lewisham will give evidence. On behalf of the Bradford trust, the vice-chairman and the chief executive will give evidence.
We have already received from the Bradford trust its corporate plan and all the information we require to enable us to ask relevant and constructive questions when the vice-chairman and the chief executive come before us. I am confident that, in the near future, we shall receive a draft business and corporate plan from Guy's and Lewisham, and all the other evidence that we require, so that the Select Committee, a Committee acting on behalf of the House, can seek to clarify what has happened in the two trust areas and their hospitals, what their plans are for the future and why there have been announcements of substantial job loses. I hope that we shall be able to ascertain where the job losses are likely to fall.
There is concern in the country about trust status, but it is sensible to realise that the reforms are with us and that the trust hospitals have not opted out of the national health service. Indeed, the hospitals are still very much within it.
Only yesterday, I was asked as Chairman of the Select Committee on Health to open a new home for Anchor Housing in Gorton, Manchester. It is a sheltered accommodation project, with nursing care, that is a joint venture between the Anchor housing association and the Central Manchester health authority. I know from what the chairman of the health authority has told me that it is making it clear to the trust hospitals within central Manchester that it does not wish to see—this is the chairman's view—the development of a two-tier health service.
The initial stages of the reforms could well produce a two-tier health service. We know that from the information that has already come to us from general practitioner fund holders. It is clear that they will exercise their financial weight and influence in getting the best possible deal and contract with a hospital, and the consultants in that hospital. In guaranteeing certain time

scales for the treatment of patients, it is clear that patients from non-fund-holding general practitioners are likely to be passed over.
I ask my right hon. Friend the Secretary of State to give an assurance that he will not tolerate a two-tier health service, and that he will give the most powerful and influential guidance from the Department to the national health service executive, under the chief executive, Duncan Nichol, who will transfer the guidance to the regional health authorities, district health authorities and health service trusts. It must be made clear that they must not permit a two-tier system. In any guaranteeing of the terms of a contract, they must accept their other responsibilities as national health service hospitals. That will go a long way to giving reassurance to those who are concerned about trusts and GP fund holders.
The initial implementation of the reforms will see the choice of where to refer patients being exercised powerfully by general practitioner fund holders. I think that my right hon. Friend the Secretary of State is aware of that. To build on my previous remarks, non-fundholding general practitioners will have their choice of where to refer patients limited by the block contract system.
It is theoretically possible for non-fund-holding GPs to make what are known as extra-contractual referrals to provider units where the patients' district health authority has not agreed a contract, but I believe that that will be limited by the residual funds that have been set aside by a purchasing district health authority that are not already committed to contract. I remind the House that residual funding has to cover any extra-contractual referrals by non-fund-holding GPs and the cost of tertiary referrals, as well as any liabilities arising out of the admission of a district patient to an accident and emergency department in other districts or regions.
In the short term, it is clear that a two-tier system may be in operation where one set of patients—those registered with the fund-holding GP practice—are advantaged in terms of choice over patients who are registered with non-fund-holding practices. The choice of referral will be further restricted where district health authorities have not set aside sufficient residual funds to pay for extra-contractual referrals.
I shall quote Marianne Rigge, the director of the College of Health, who wrote to the Select Committee on Health to say:
most GPs and their patients are going to have less choice than in the past.
I believe that that will be only in the short term. Marianne Rigge continues:
No longer will it be a purely clinical decision by a consultant to whom a GP has referred a patient, that he will do that operation. There will be a new dimension—that of payment. The reasons behind the decision to operate may become financial rather than clinical. Patients may find themselves being put into a new sort of waiting list—for the money, rather than for the treatment.
District health authorities that have general practitioner fund holders in their district may set priorities—this is important, and it has not been mentioned so far—that are different from those of general practitioners. That may cause problems, and no formal structure has been instituted to resolve them. The only mechanism for reconciliation is informal negotiation.
As my ministerial colleagues are aware, DHAs have little power to control general practitioner referring.


Potential financial problems will be created if insufficient reserves are kept by a DHA to fund the extra referrals which I have already mentioned. The Department of Health predicted that most general practitioner fund holders would agree block contracts based on previous years' referral patterns.
That has not always happened. Some fund holders are keen to change their referral patterns this year; that means that they are seeking what I can only describe as "better deals" for their patients now, and are prepared to use their budget-holding powers to buy services from hospitals that can offer shorter waiting times, less extensive care or better-quality treatment—or a combination of all three.
According to Health Service Journal, Oxford health authority asked its GP fund holders to tie up 80 per cent. of their budgets in hospital contracts, leaving themselves 20 per cent. "to play the market". But let me present the other side of the coin: all is not necessarily rosy for fund holders. We have already received evidence that some of them are complaining that their budgets are too small to give them any clout with potential advisers. To get around that problem, some GPs are considering forming fund-holding consortia, in the hope that that will increase their purchasing power.
Let me add another caveat. If a GP spends his or her budget before the end of a financial year, the GP will play the role of "rationer of health care", and may well create a waiting list all of his—or her—own.
The implementation of the new reforms will cause problems, but, as I said at the beginning of my speech, these reforms are already with us. We on the Select Committee consider it our duty to ensure that they work, and also to ensure—with the help of the NHS professions and the Department of Health—that the Government's objectives are achieved. I entirely share those objectives, which are to provide better value for money in the delivery of health care, to make the system more patient-responsive and to ensure that a larger percentage of the total budget is spent directly on patient care and the delivery of treatment.
I believe that I speak on behalf of many other people when I suggest to the hon. Member for Livingston (Mr. Cook) that we should accept, for the moment at least, that the NHS reforms are with us. Would it not have been better for us to discuss today how those reforms could be improved to the benefit of the people, rather than merely bandying statistics and throwing political vitriol across the Floor? I personally believe that the Government are entirely sincere in their wish to achieve their laudable objectives—which, I suspect, are shared by every hon. Member, whatever his party.
Having said that, let me again ask my right hon. Friend the Secretary of State for an assurance that he will do his utmost—by means of firm guidance and encouragement from the top—to make it clear that the Government have no intention of establishing a two-tier health service. Already, the lead has been taken by a number of trust and district health authority chairmen, although not, as yet, by any regional health authority chairmen. If my right hon. Friend follows up that lead, he will carry people along with the reforms—which, after all, are already being implemented.
I am convinced that, if my right hon. Friend takes that course, we shall be able to remove the NHS from the political arena—where, today, it has been the subject of such a negative and sterile debate.

Mr. Jimmy Wray: Listening to today's debate, I sometimes wondered whether I was at the London Palladium. From what the Government have said, it might be imagined that there was nothing wrong with the health service. Those of us who represent constituencies that have suffered from the lack of Government expenditure know otherwise. For four years, I have been following up my ten-minute Bill asking the Government to show compassion for the thousands of women who die of cervical cancer each year. It would cost only £15 million, but the Government—to a man and to a woman—voted against my Bill. That is the kind of Government we are dealing with.
The politicians' graveyard on the Conservative Benches evokes no sympathy in me. These will soon be yesterday's men and women. For 12 years, the electorate have given them their chance, and what have they done? They introduced the poll tax, which they have now been forced to abandon. Now they have a new philosophy—health service trusts. Why do they not do something about the people who are handing out private insurance, telling the purchasers that if they take a health service bed instead of one in the private sector they will receive £100 a day? Has any Conservative Member received £100 a day from private health insurance? I think so; I know people who have received that kind of money.
My hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) has raised with the Department of Health the plight of those who, through no fault of their own, were injected with HIV. They asked, through their lawyers, whether they would be given compensation. My hon. Friend wrote to the Secretary of State on 28 February, but he has still received no reply. That is the sort of compassion that the Department is showing.
The Government say that there is nothing wrong with the health service, and that they believe that a two-tier system will work. If there is nothing wrong with the health service, why is there a waiting list of 70,000 in Scotland, and waiting lists of 50,000 and 800,000 in Wales and England respectively? Do the Government honestly think that the people will accept the closure of new hospitals because of the lack of staff and equipment?
The Government will find the answers in the ballot box. They believe in the ballot box for trade unions; they do not believe in a health service ballot box. When Guy's hospital —the Government's flagship—became a trust, was there any consultation with the workers? It is certainly clear that the Prime Minister's office is not briefing him properly. When the first Scottish hospital asked for advice about trust status, the consultants opposed the move by 87 votes to two. The Government may believe that the men and women of England and Scotland who work for the health service are ready to sell it out, but they will receive a different answer at the next general election.
I find it hard to believe that a trust set up to show the way in Britain should forecast, in its business plan, a profit of £1·5 million, and finish its first year with a deficit of £7·5 million. Who will help it out? Certainly not the present Government.
When asked about the prospect of 600 people at Guy's hospital being put on the dole, the Secretary of State said, "It is not our business; it is the board's business." I believe that, when both Scottish and English Ministers said at the Perth conference that they would not take hospitals out of the NHS, they meant it. Because of the way in which they have set up this project, the system is isolated and fragmented and ready for privatisation. That is their idea and that is what the trusts are all about—the Americanisation and privatisation of the health service. "Don't trust the trusts," is the slogan, and do not trust the Tories either.
There certainly has not been any consultation in Scotland, and if the people who asked for consultation had got it, they certainly would have said a big no to the trusts. It is nonsense to say that the people of Scotland want funded practices. Out of 1,000 practitioners, only 46 applied for advice on funded practices and only four are thinking the matter over. Nobody in the health service wants funded practices. They want decent hospitals, beds and more money invested in the service.
The health boards have done a great job for the Government, especially Lothian health board, which has already drawn up secret plans. If the health boards are really interested in dealing with the shortage of beds, why are they recommending the closure of Edinburgh Royal with 2,000 beds, one of Scotland's largest teaching hospitals, and replacing it with a new hospital with 700 fewer beds? That is the type of thing they propose. It is all about selling off assets. There will be a carrot in the form of the hospitals' assets—the beautiful buildings and greenery and the acres of land that are prime sites for building.
I hope that the people of Lothian are aware of Lothian health board's plans to close part of Eastern general hospital and of its plans for Roodlands general hospital, the Simpson memorial maternity pavilion and the Princess Alexandra eye pavilion. No doubt, the hon. Members representing constituents in that area will have something to say about it.
I shall not take up any more time, Mr. Speaker, as many hon. Members have been sitting here for hours hoping to catch your eye. I shall simply say that the people of the United Kingdom and Scotland are not interested in trusts or funded practices.

Mr. David Evan: I have heard from hon. Members several instances of the national health service seeming to have failed the patient. Last night, I was out with one of my constituents, when he collapsed. He was taken to St. Thomas's where he received first-class treatment. He could not have praised more highly the efforts of the people who serve the hospital. I have heard too much from the Opposition this evening about how incompetent and inefficient some of our hospitals are. I disagree profoundly with that.
The national health service became operational on 5 July 1948. Let me put that date into perspective. Electricity generation was the task of the British Electricity Authority, the forerunner of the now defunct Central Electricity Generating Board. British Rail, established only a year earlier, was investigating technologies to

replace the steam locomotive. The National Liberal party, at its June conference in 1948, voted to change its name —surprise, surprise.
The electricity industry has now been privatised. BR, which has run out of steam, is currently in the process of restructuring its organisation. The time has surely now come for the NHS to realign itself to face the challenges of the 1990s, not those of the 1940s. Demographic changes, new social aspirations and advances in medical science have all contributed to the need for a new service culture.
The Opposition, however, are happy, as we all know, to keep the NHS in a time warp. Their Front Benchers pour scorn on the Government's reforms; to a man and a woman, they fail to grasp that the NHS is in desperate need of an overhaul. All they can talk about is how much more money they would spend—a cheap commentary, without any economic foundation whatsoever.
The Opposition's shallow grasp of health economics was revealed last year, when the hon. Member for Livingston (Mr. Cook) committed the Labour party to spending some £3 billion over the lifetime of a Government to restore what he called "NHS underfunding". He failed to realise that the Government have increased spending by more than £6 billion over the last two years alone. More impressively, during their first 11 years in office, this Government increased spending by 52 per cent. There are 30,000 more patients treated every week, 16,000 more GPs, 5,000 more in the hospital service, and 60,000 more nurses and midwives.
In addition to channelling unprecedented sums into the NHS, my right hon. Friend and his ministerial team have wrestled successfully with the institutional problems that have long plagued the health service. The NHS has become what one might call a bureaucratic ghetto, with over 1 million employees, the largest employer in Europe.
The NHS trust hospitals form the vanguard of the Government's latest reforms. On 1 April, 57 were created, and 130 others hope to join them by next year. They have an ongoing restructural process which will drag the national health service into the 21st century. Hospitals are now able to release themselves from the pervasive bureaucracy that has stifled local initiative for so long—a malaise which is particularly relevant to the North-West Thames regional health authority, which administers the funding of hospitals in my constituency.
My local authority, East Hertfordshire, has been the victim of gross mismanagement dished out by the North-West Thames regional health authority. The six shire authorities have had to stand by and witness their prudent fiscal policies being translated into cuts, while funds have been redirected into free-spending inner-London health authorities. The results are absurd. The shire authorities, which have 43 per cent. of the region's population, receive only 31 per cent. of the cash. In other words, where £1 is spent in Brent, only 75p is spent in Welwyn Hatfield.
A comparison of staffing ratios in East Hertfordshire as against the Riverside health authority produces even more laughable results. East Hertfordshire has 19 occupational therapists compared with Riverside's 120; a derisory 18 physiotherapists compared to inner London's 119; and 17 district nurses compared to 179—and this is for the same number of people in Riverside as in East Hertfordshire.
The most graphic example of this towering ineptitude is seen in the history of the Westminster and Chelsea hospital project. The cost of that scheme started off at £78 million.


It then went up to £130 million. It is now over £200 million, and every capital project in the shire district has had to be shelved for three years. That is due to the incompetence of the North West Thames regional health authority and its chairman. Hospital trusts will offer an escape from that quagmire. They are an imaginative, far-sighted response to the archaic thinking prevalent in the old organisational structure.
I come now to the caring Labour party and an article in The Times in 1978 with the headline "Hospital is to turn away patients with cancer". It says:
'"Patients with breast, lung and other cancers and abortion cases are to be turned away from the Kingston hospital, Surrey, because of industrial action by national health services workers and supervisors', the hospital said yesterday. From midnight next Tuesday even known cancer cases will be denied admission and lives immediately threatened. Investigative surgery, even where there is strong suspicion of the life-threatening condition, will not take place.
On 21 October 1978,The Times said:
Talks aimed at ending the dispute involving hospital engineers and work supervisors broke down last night after union leaders rejected an appeal from Mr. David Ennals, Secretary of State for Social Services, for a return to work, because, he said, patients were dying Mr. Ennals, who had been touring the West Norwich hospital where services had been badly affected by the dispute said: 'I appeal to those who are taking industrial action. For God's sake suspend it. For God's sake go back to work and stop playing around with people's lives. They can no longer take it out on patients. There is no doubt that some people have already died. Every day and week that goes by, the danger is there.'
Far from the medical garden of Eden, hon. Members will see an institution ravaged by union militancy and retarded by poor leadership mirrored in the Labour party. If the Labour party gets in at the next general election, God help us.

Mrs. Margaret Ewing: I must of necessity compress my remarks, but I have a local issue that I wish to raise.
My constituency is also covered by what is known as West unit within the Grampian health board. West unit has recently applied for additional information on trust status. During the past few weeks, many of my constituents—not only those who work in the health service—have made clear their genuine concerns and fears about the situation.
I start from the basic principle that the NHS is not a business to be organised by managers. People are at the heart of the service. We are the providers of the health service and we must understand the profound affection that people throughout the country have for it. Some of my constituents' concerns are based on the Government's record in the preparation for the changes to the NHS.
I refer in particular to what was said not by the Secretary of State's predecessor but by his predecessor's predecessor—the golden boy of the Conservative party, the right hon. Member for Croydon, Central (Mr. Moore) —who was charged with bringing forward fund-holding practices and trust status. In an address to the Young Conservatives, he said:
I foresee a substantial increase in private medical care with the NHS remaining as a safety net.

Against that kind of background, is it any surprise to the Government that people should be suspicious? Why should any Minister refer to the NHS as a safety net unless the Government intend to implement a two-tier system?
The Government were asked by the royal colleges, the British Medical Association and the Select Committee to implement pilot schemes. Instead, 57 trusts were established and it is already clear from their record that not all is well. We have seen what has happened in three of them and we are deeply concerned that the Government are continuing to push trust status against that background. At the very least, they should consider abandoning the prospect of further trusts until we can analyse and evaluate further what is happening in those already established.
My constituents are also worried about what is meant by the consultation process. In theory, there is consultation before trust status is agreed to, but it is essentially a meaningless exercise because, even where the medical profession and the public have made clear their antagonism towards the idea of a trust, it has still gone ahead.
Those who are charged with delivering the health service—in our area, the Grampian health board—say that they are required to take a view on any trust application and are well placed to advise on the likely impact of the proposal on the local provision and the quality of health care. Those people are not from the medical profession—they are business men and Tory appointees. In addition, within the Grampian health board area, the health councils have been reduced from five to one. In my constituency, the most northerly part of the Grampian region, we have only three representatives on the health council. Democracy appears to have gone out of the window.
Against that background, given the exigencies of time, I make a plea to the Government to endorse the view being so clearly expressed everywhere that there must be no further trusts until there has been a clear evaluation and analysis of the existing ones.

Ms. Harriet Harman: Tonight the Secretary of State stood before the House of Commons as a man in whom the public have not a shred of confidence. No one believes the Government's promises on the NHS any more. No one trusts the Government because they have broken every promise that has been wrung from them. Above all, they have broken their promise that we can keep our national health service. Instead, we have seen hospitals opting out, NHS queue-jumping and a relentless drive towards a United States-style, two-tier health service.
No one believes the Government's promise that they are really committed to the NHS, and why should we? We were told that the opted-out hospitals were to give people a say at local level, to devolve decision-making down to local communities, but then we learned that there were to be no ballots, so people at local level were not to have a say about whether their hospital should opt out. Despite the overwhelming opposition of people at local level, the Government were clearly determined to ride roughshod over local opinion. How can that be giving people a say at local level when they cannot even have a say in whether their hospital should opt out?
We were told that opting out would not mean job losses and all that we said was supposedly scaremongering. The gap between rhetoric and reality is well illustrated in a little booklet entitled "Guy's Hospital Gazette", which says:
We are friendly and fun. This is a great place to work … The management cares, really cares about people … Having fun is considered as legitimate!
That is the Guy's self-governing trust. Just as that document was being circulated to the staff, we were told that 600 jobs were to go. We were then told that those job losses would not hit services, but then a leaked memorandum from Guy's hospital told us that there would be
inevitable reductions in direct patient care services.
So the job losses that we were told would not happen will indeed hit patient care services, although the Government tried to conceal the truth from the people who depend on those services.
We were told that opted-out hospitals would not be cut loose from the national health service, but as the scale of the cuts became clear at Guy's and then in Bradford, the Secretary of State said, "It's nothing to do with me—I am only the Secretary of State. Guy's has opted out, as has Bradford, so why don't you ask the chief executives of opted-out hospitals?" The Secretary of State has a choice: he can either accept responsibility for cuts in services or he can admit that hospitals have opted out of the NHS. He cannot have it both ways.
We were told that opted-out hospitals would still be open and accountable, but in the 200-page application for Guy's opt-out nothing was said about the swingeing and immediate cuts in jobs and services. We have never been allowed to see the secret business plan that the trust submitted to the Government. Why should we trust the Government when they will not show us documents that trusts have submitted to them? The Government are supposed to be running the national health service, but they are operating it like the secret service.
The Government denied that the internal market would produce a two-tier national health service—

Mr. Andrew Smith: As regards the two-tier service, does my hon. Friend share my deep concern about the report to the Oxfordshire community health council this week to the effect that a contract is being concluded with Swindon district health authority giving patients from that authority a guarantee of a scan on the marvellous magnetic resonance imager at the John Radcliffe hospital within two weeks, when the average waiting time for Oxfordshire patients is three months? Does that not show that it is the ability to fix financial deals and not medical need which determines access to treatment?

Ms. Harman: Moreover, because all those people will have priority in queue-jumping, everyone else will have to wait even longer. Within weeks of the establishment of an internal market, queue-jumping has been institutionalised in the NHS, and the Secretary of State knows it. It happened first in Watford. Let us be absolutely clear what we are talking about. Two GP fund-holding practices have 10 per cent. of the patients in the district and 90 per cent. are with other GPs. As a result of priority admission being arranged for the patients of the two fund-holding practices, the other 90 per cent. of patients will have to wait longer.
The same arrangement was made in Bart's, and now an arrangement is being negotiated with Guy's whereby not only will some GP patients have priority admission, and therefore everyone else will have to wait longer, but some people will get priority when it comes to who performs the operation and whom they see. Advantage will be negotiated. Some patients will see consultants and senior registrars and everyone else will be relegated, irrespective of clinical need to more junior members of staff. That is the logic of the internal market, and it will hit not only Watford, Bart's and Guy's, but all hospitals in due course.
When a person is treated will depend not on how urgent the clinical condition is, but on whether the GP is a budget-holder and whether the district health authority has been able to fix a preferential deal. As a result, there will be patients in adjacent beds for hip operations, one having waited 18 months in pain and agony and the other having waited only two weeks. I shall be interested to know whether Conservative Members would defend that situation. If that is not a two-tier health service, I do not know what is.
Inconsistencies have started to appear in the stories from different members of the Government, as always happens with people who are up to no good. The Prime Minister is saying quite clearly:
Operations are done on the basis of clinical need
and again:
I shall repeat that in case he did not fully hear it first time: operations are done on the basis of clinical need."—[Official Report, 7 May 1991; Vol. 190, c. 620.]
Yet the Secretary of State has admitted tonight that queue-jumping arrangements will be negotiated, so it will be contracts and wheeling and dealing between GP budget-holders, hospitals and district health authorities that will determine priorities rather than clinical need. No wonder, to use the words of Dr. Ken Grant, district general manager of the City and Hackney health authority, in a letter to consultants:
This does mean that the question of equity has gone out of the window"—
I should like to know whether the Secretary of State accepts that—
but this is the reality of GPs holding their own practice budgets for elective work.
Another promise that the Government have broken is that people will have a choice about where they go for treatment. Choice is being taken away from the patient in consultation with the GP.

Mr. Hind: They never had it before.

Ms. Harman: Yes, they did—[interruption.] If hon. Members will give me one—[Interruption.] Take maternity services, where there has been a long tradition—

Mr. Speaker: Order. I think that it would be better if the hon. Lady directed her speech through me.

Ms. Harman: If we take maternity services, there has been a long tradition, which we should encourage, of women choosing where to have their babies on the basis of what was convenient for them, what sort of care they wanted and the style of delivery that they wanted. That was described as cross-boundary flow and operated under the last Labour Government and until now. However, the decision about which hospital she will go to will not now be taken by a woman in consultation with her GP but by the district health authority manager, who will place block


bookings for maternity services for the district. If a woman wants to have a baby in a hospital other than the one where the contract has been placed, she will have to apply for access to the extra-contractual referral fund and go through the procedure. There is simply not enough money in the contingency funds to safeguard choice, tertiary referrals, and so forth.
If the Government were honest, they would admit that choice has gone out of the window with the internal market. They also ought to be honest and admit that they are promoting private health care. They have allowed waiting lists to grow so that more and more people have been driven to paying for private health care. The Government have been giving tax relief for private health care for the elderly. Now the private sector is stalking further into the NHS, with private contractors for cleaning and laboratory services and private deals for private hospitals on NHS sites.
Perhaps the Minister in her winding-up speech will take the opportunity to stop in its track the secret deal that AMI Healthcare is negotiating to build a private hospital on the site of the QEII hospital in Welwyn Garden City to lure NHS consultants and nurses away from their patients to do private work and to make everyone else wait longer.
We remain steadfast in our straightforward opposition to the internal market, where doctors have to put cash before care, where profits come before patients. We shall abolish the internal market and we shall remain steadfast in our opposition to opting out. We shall bring opted-out hospitals back within the NHS. The Government can no longer carry on riding roughshod over public opinion. They are wildly out of step with the mood of the public. They must admit—as they did with the poll tax—that they have got it wrong.

The Minister for Health (Mrs. Virginia Bottomley): We are becoming accustomed to a litany of carping hysteria, negative stories and misleading information. I shall focus on some of the elementary points. "Take maternity services," said the hon. Member for Peckham (Ms. Harman). Well, let us take maternity services. What has happened? My right hon. Friend the Secretary of State informed the House that perinatal mortality has never been lower. In the past 10 years, we have halved the number of babies dying in childbirth and in the past 15 years we have halved the number of women dying in childbirth. That is what I call "taking maternity services". More than that, in 10 years we have gained one third more midwives. We are profoundly and sincerely committed to concentrating on the improvement of the identifiable and measurable health care indicators.
As for waiting lists, the last Labour Government, like every Labour Government, left power with waiting lists increased; there was a 48 per cent. increase in waiting lists during their term of office. Waiting lists have come down 7 per cent. under the Conservative Government. We want to do better, and we will do better. If ever there was encouragement for the private sector, it was the fact of the Labour party being in power. As has been said clearly in the debate, the clinical judgment and the priority which operated when the Labour party was in power were exercised by the COHSE official at the gate. We

understand that. With one third of the parliamentary Labour party sponsored by one of the health unions, we understand where Labour's loyalties lie.
Our commitment is clear: it is to continue to improve the health care of our people. No, we do not want to argue with the AMI initiative at Welwyn Hatfield. If the private sector can flourish and develop, that does not offend us, because we are concentrating on improving the functioning, the management and the care provided by our national health service.
None of us is prepared to listen to lectures from the Labour party about commitment, investment and plans for the health service because the Government have invested in the service and increased the number of doctors and nurses. I do not know how the hon. Member for Livingston (Mr. Cook) dared to talk about the record of staff in the face of the cuts in pay that health care staff suffered under Labour.
There has been discussion today about a two-tier service. I want to give an example of what I think would have created a two-tier service. Hon. Members are well advised to recall the debates on the introduction of the general practitioner contract. Almost all now agree that the contract has been a major force for good. Children are immunised and women are screened. It is becoming a health service, not a disease service. There is more health promotion.
What was the line of the Labour party? According to Labour, it was too much to expect GPs in inner-city areas to meet the targets that the rest of the country had to meet. The Labour line was that targest should be lowered in inner-city areas. That is what I call a two-tier health service. Our approach was not to lower the targets for some groups in the community but to make sure that those GPs in inner-city areas received additional deprivation payments. We want to make sure that all parts of the community receive the best possible patient care.
I am grateful to my hon. Friend the Member for Macclesfield (Mr. Winterton) for his contribution and for his recognition that the health reforms are here to stay. We want to improve the health care of all. Yes, trusts are at the forefront of changes. GP fund holders can use their purchasing power. They have the control and autonomy to do what a good GP has always done, which is to advise patients on how to get the best deal from the various hospitals and provisions. That is the role of the GP. The GP is the advocate for the patient. We want GPs to push forward the frontiers, but we want the districts, which have much greater purchasing muscle than GP fund holders, to make sure that they seek the same quality improvements so that they can get the same results in waiting times.
Again, what is the approach of the Labour party? It is equal misery for all, levelling down, and the lowest common denominator. Labour thinks that it would be wrong for some people to make progress because others might be left out. Our approach is to have the best possible health care for all the people. If trusts can move forward improvements in quality and if GP fund holders can use their leverage to improve health care, we will welcome and endorse that.
I should like to address some of the speeches made in the debate. The right hon. Member for Blaenau Gwent (Mr. Foot) spoke with feeling about BMA opposition to the health service. He quoted it as saying, "We didn't understand what the reality of the service would be." We know how that feels. We are absolutely confident that, as


the reforms bed in and as we move forward, the BMA and many others will understand precisely what they mean for the health service.
The right hon. Gentleman seemed in his splendid oratory, which all of us much enjoyed, to overlook the fact that it was his party that introduced cash limits for the health service. On a precise point, he mentioned the role of physiotherapists. I endorse the point that it is often the professions allied to medicine which can make a major contribution to improving patient care. I can inform the right hon. Gentleman that there has been a 35 per cent. increase in professions allied to medicine over the past 10 years. Certainly physiotherapists have an important part to play.
I thank my right hon. Friend the Member for Brentford and Isleworth (Sir B. Hayhoe), who has particular knowledge of and expertise in the health service. I am grateful for his recognition of what is being done about junior doctors. Much of the work in which I have been involved in that respect has been built on his work in achieving a balance. That was very much the model that was put to me when there was talk about having a ministerially led team to tackle an outdated, unacceptable way of training our juniors. How pleased I am that the consultants and the juniors have found a way through the hurdle. We are setting up regional task forces and guidance will be produced shortly. We are determined to bring to an end an unacceptable way of training doctors.

Mr. Dickens: Does my hon. Friend agree that the NHS trust within the national health service has the opportunity to reintroduce matrons into hospitals? One hospital has already done that. New managements could make similar decisions. Most people would welcome that approach.

Mrs. Bottomley: It is always worth while giving way to my hon. Friend. He has made a point that meets with great support. Indeed, he has made two important points. First, the culture around the matron was that she was a person who knew what was going on. The matron understood how the hospital was organised. That is part of our emphasis on better management. We have to tackle the problem. We cannot allow the health service to run on in the way that it has worked traditionally. We need people to take responsibility.
Secondly, my hon. Friend was right to identify the role of nurses. My right hon. Friend the Secretary of State has carried forward the cause of nurses by putting the chief nursing officer on the policy board. We introduced Project 2000, a much more appropriate way of training nurses, who are now much better paid.
Coming back to my right hon. Friend the Member for Brentford and Isleworth, who spoke about nurse prescribing, we want progress as quickly as possible. It is a dreary feature of Government that we need to make sure that the list and the cost benefit are correct and that liaison with other professionals has been properly addressed.

Mr. Hind: Will my hon. Friend make it clear that the problems that we have discussed in the debate relating to London hospitals are essentially London problems? Will she make that clear before the Labour party carries its nasty propaganda to the north of England and frightens many constituents in other parts of the country with its suggestions about NHS trusts?

Mrs. Bottomley: Indeed, my hon. Friend is so right. Of course, the Labour party has total amnesia. Not only did Labour introduce cash limiting on the health service and prescription charges, but it set up the resource allocation working party, identifying then the dilemma which we face about the provision of consultants and beds in inner cities, based on historic provision, at a time when there has been enormous expansion outside London. The reforms will help us better to plan services and to improve the care that we provide.
We have no doubt that these reforms will build a better health service. We have a right to have pride in our record. We have invested in an unprecedented way. We have worked with the service, and for the service, for patients. Above all, putting patients first is the focus of our work. I hope that all hon. Members will reject the Labour party's motion. The Labour party has no right to speak for the health service. Its only loyalty is, of course, to the health service unions. Ours is the record, ours is the policy, and we shall see a stronger, healthier and more effective health service as a result of these reforms.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 184, Noes 296.

Division No. 142]
[7.00 pm


AYES


Abbott, Ms Diane
Darling, Alistair


Adams, Mrs Irene (Paisley, N.)
Davies, Rt Hon Denzil (Llanelli)


Allen, Graham
Davis, Terry (B'ham Hodge H'l)


Archer, Rt Hon Peter
Dewar, Donald


Armstrong, Hilary
Dixon, Don


Ashdown, Rt Hon Paddy
Dobson, Frank


Ashley, Rt Hon Jack
Doran, Frank


Ashton, Joe
Douglas, Dick


Banks, Tony (Newham NW)
Duffy, A. E. P.


Barnes, Harry (Derbyshire NE)
Dunwoody, Hon Mrs Gwyneth


Barnes, Mrs Rosie (Greenwich)
Eadie, Alexander


Barron, Kevin
Eastham, Ken


Battle, John
Ewing, Mrs Margaret (Moray)


Beckett, Margaret
Fatchett, Derek


Beith, A. J.
Fearn, Ronald


Bell, Stuart
Flannery, Martin


Bellotti, David
Flynn, Paul


Benn, Rt Hon Tony
Foot, Rt Hon Michael


Bennett, A. F. (D'nt'n &amp; R'dish)
Foster, Derek


Bermingham, Gerald
Foulkes, George


Blair, Tony
Fraser, John


Blunkett, David
Fyfe, Maria


Boateng, Paul
Galbraith, Sam


Boyes, Roland
Galloway, George


Bray, Dr Jeremy
Garrett, John (Norwich South)


Brown, Nicholas (Newcastle E)
Garrett, Ted (Wallsend)


Brown, Ron (Edinburgh Leith)
George, Bruce


Buckley, George J.
Godman, Dr Norman A.


Caborn, Richard
Golding, Mrs Llin


Callaghan, Jim
Gordon, Mildred


Campbell, Menzies (Fife NE)
Gould, Bryan


Campbell, Ron (Blyth Valley)
Graham, Thomas


Campbell-Savours, D. N.
Griffiths, Nigel (Edinburgh S)


Carlile, Alex (Mont'g)
Griffiths, Win (Bridgend)


Carr, Michael
Grocott, Bruce


Cartwright, John
Hardy, Peter


Clark, Dr David (S Shields)
Harman, Ms Harriet


Clarke, Tom (Monklands W)
Haynes, Frank


Clwyd, Mrs Ann
Heal, Mrs Sylvia


Cohen, Harry
Henderson, Doug


Cook, Robin (Livingston)
Hinchliffe, David


Corbett, Robin
Hogg, N. (C'nauld &amp; Kilsyth)


Cousins, Jim
Home Robertson, John


Cryer, Bob
Hood, Jimmy


Cummings, John
Howell, Rt Hon D. (S'heath)


Cunliffe, Lawrence
Howells, Geraint


Dalyell, Tam
Howells, Dr. Kim (Pontypridd)






Hughes, Robert (Aberdeen N)
Powell, Ray (Ogmore)


Illsley, Eric
Prescott, John


Ingram, Adam
Radice, Giles


Janner, Greville
Randall, Stuart


Kaufman, Rt Hon Gerald
Redmond, Martin


Kennedy, Charles
Rees, Rt Hon Merlyn


Lamond, James
Reid, Dr John


Leighton, Ron
Richardson, Jo


Lestor, Joan (Eccles)
Robinson, Geoffrey


Lewis, Terry
Rogers, Allan


Litherland, Robert
Rooker, Jeff


Livingstone, Ken
Rooney, Terence


Lofthouse, Geoffrey
Ross, Ernie (Dundee W)


Loyden, Eddie
Ruddock, Joan


McAllion, John
Salmond, Alex


McCartney, Ian
Sedgemore, Brian


Macdonald, Calum A.
Sheerman, Barry


McFall, John
Sheldon, Rt Hon Robert


McKay, Allen (Barnsley West)
Shore, Rt Hon Peter


McKelvey, William
Short, Clare


McLeish, Henry
Sillars, Jim


McMaster, Gordon
Skinner, Dennis


McNamara, Kevin
Smith, Andrew (Oxford E)


McWilliam, John
Smith, C. (Isl'ton &amp; F'bury)


Madden, Max
Smith, Rt Hon J. (Monk'ds E)


Mahon, Mrs Alice
Soley, Clive


Marek, Dr John
Spearing, Nigel


Marshall, David (Shettleston)
Steel, Rt Hon Sir David


Marshall, Jim (Leicester S)
Steinberg, Gerry


Martin, Michael J. (Springburn)
Straw, Jack


Martlew, Eric
Taylor, Mrs Ann (Dewsbury)


Maxton, John
Taylor, Matthew (Truro)


Meacher, Michael
Thompson, Jack (Wansbeck)


Michie, Bill (Sheffield Heeley)
Vaz, Keith


Michie, Mrs Ray (Arg'l &amp; Bute)
Walley, Joan


Morley, Elliot
Wardell, Gareth (Gower)


Morris, Rt Hon A. (W'shawe)
Welsh, Andrew (Angus E)


Morris, Rt Hon J. (Aberavon)
Wigley, Dafydd


Mowlam, Marjorie
Wilson, Brian


Mullin, Chris
Winnick, David


Nellist, Dave
Wise, Mrs Audrey


Oakes, Rt Hon Gordon
Worthington, Tony


O'Brien, William
Wray, Jimmy


Owen, Rt Hon Dr David



Patchett, Terry
Tellers for the Ayes:


Pendry, Tom
Mr. Jimmy Dunachie and Mr. Thomas McAvoy.


Pike, Peter L.





NOES


Adley, Robert
Brazier, Julian


Aitken, Jonathan
Bright, Graham


Alexander, Richard
Brown, Michael (Brigg &amp; Cl't's)


Amery, Rt Hon Julian
Browne, John (Winchester)


Amess, David
Buchanan-Smith, Rt Hon Alick


Amos, Alan
Buck, Sir Antony


Arbuthnot, James
Budgen, Nicholas


Aspinwall, Jack
Burns, Simon


Atkins, Robert
Burt, Alistair


Baker, Rt Hon K. (Mole Valley)
Butler, Chris


Baker, Nicholas (Dorset N)
Butterfill, John


Batiste, Spencer
Carrington, Matthew


Beaumont-Dark, Anthony
Carttiss, Michael


Bendall, Vivian
Cash, William


Bennett, Nicholas (Pembroke)
Chalker, Rt Hon Mrs Lynda


Benyon, W.
Channon, Rt Hon Paul


Bevan, David Gilroy
Chapman, Sydney


Blackburn, Dr John G.
Chope, Christopher


Blaker, Rt Hon Sir Peter
Churchill, Mr


Body, Sir Richard
Clark, Dr Michael (Rochford)


Bonsor, Sir Nicholas
Clark, Rt Hon Sir William


Boscawen, Hon Robert
Clarke, Rt Hon K. (Rushcliffe)


Boswell, Tim
Colvin, Michael


Bottomley, Peter
Conway, Derek


Bottomley, Mrs Virginia
Coombs, Anthony (Wyre F'rest)


Bowden, A. (Brighton K'pto'n)
Coombs, Simon (Swindon)


Bowden, Gerald (Dulwich)
Couchman, James


Bowis, John
Cran, James


Boyson, Rt Hon Dr Sir Rhodes
Currie, Mrs Edwina


Braine, Rt Hon Sir Bernard
Curry, David


Brandon-Bravo, Martin
Davies, Q. (Stamf'd &amp; Spald'g)





Davis, David (Boothferry)
Key, Robert


Day, Stephen
King, Roger (B'ham N'thfield)


Devlin, Tim
Kirkhope, Timothy


Dickens, Geoffrey
Knapman, Roger


Dicks, Terry
Knight, Greg (Derby North)


Dorrell, Stephen
Knight, Dame Jill (Edgbaston)


Douglas-Hamilton, Lord James
Knowles, Michael


Dover, Den
Knox, David


Dunn, Bob
Lamont, Rt Hon Norman


Durant, Sir Anthony
Lang, Rt Hon Ian


Dykes, Hugh
Latham, Michael


Eggar, Tim
Lawson, Rt Hon Nigel


Emery, Sir Peter
Lee, John (Pendle)


Evans, David (Welwyn Hatf'd)
Leigh, Edward (Gainsbor'gh)


Evennett, David
Lennox-Boyd, Hon Mark


Fairbairn, Sir Nicholas
Lilley, Rt Hon Peter


Fallon, Michael
Lloyd, Sir Ian (Havant)


Favell, Tony
Lloyd, Peter (Fareham)


Field, Barry (Isle of Wight)
Lord, Michael


Fishburn, John Dudley
Luce, Rt Hon Sir Richard


Forman, Nigel
Lyell, Rt Hon Sir Nicholas


Forsyth, Michael (Stirling)
McCrindle, Sir Robert


Forth, Eric
Macfarlane, Sir Neil


Fox, Sir Marcus
MacGregor, Rt Hon John


Franks, Cecil
Maclean, David


Freeman, Roger
McLoughlin, Patrick


French, Douglas
McNair-Wilson, Sir Michael


Fry, Peter
McNair-Wilson, Sir Patrick


Gardiner, Sir George
Madel, David


Gill, Christopher
Major, Rt Hon John


Gilmour, Rt Hon Sir Ian
Malins, Humfrey


Glyn, Dr Sir Alan
Mans, Keith


Goodhart, Sir Philip
Maples, John


Goodlad, Alastair
Marland, Paul


Goodson-Wickes, Dr Charles
Marlow, Tony


Gorman, Mrs Teresa
Marshall, Sir Michael (Arundel)


Gorst, John
Martin, David (Portsmouth S)


Grant, Sir Anthony (CambsSW)
Mates, Michael


Greenway, Harry (Ealing N)
Maude, Hon Francis


Gregory, Conal
Mayhew, Rt Hon Sir Patrick


Griffiths, Sir Eldon (Bury St E')
Mellor, Rt Hon David


Griffiths, Peter (Portsmouth N)
Meyer, Sir Anthony


Ground, Patrick
Miller, Sir Hal


Grylls, Michael
Mills, Iain


Gummer, Rt Hon John Selwyn
Miscampbell, Norman


Hague, William
Mitchell, Andrew (Gedling)


Hamilton, Hon Archie (Epsom)
Mitchell, Sir David


Hamilton, Neil (Tatton)
Moate, Roger


Hannam, John
Monro, Sir Hector


Hargreaves, A. (B'ham H'll Gr')
Montgomery, Sir Fergus


Hargreaves, Ken (Hyndburn)
Moore, Rt Hon John


Harris, David
Morrison, Sir Charles


Haselhurst, Alan
Moss, Malcolm


Hayes, Jerry
Moynihan, Hon Colin


Hayhoe, Rt Hon Sir Barney
Mudd, David


Hayward, Robert
Neale, Sir Gerrard


Heath, Rt Hon Edward
Nelson, Anthony


Heathcoat-Amory, David
Neubert, Sir Michael


Hicks, Mrs Maureen (Wolv' NE)
Nicholls, Patrick


Hicks, Robert (Cornwall SE)
Nicholson, David (Taunton)


Higgins, Rt Hon Terence L.
Nicholson, Emma (Devon West)


Hind, Kenneth
Norris, Steve


Hogg, Hon Douglas (Gr'th'm)
Oppenheim, Phillip


Holt, Richard
Page, Richard


Howard, Rt Hon Michael
Paice, James


Howarth, Alan (Strat'd-on-A)
Parkinson, Rt Hon Cecil


Howarth, G. (Cannock &amp; B'wd)
Patnick, Irvine


Howe, Rt Hon Sir Geoffrey
Patten, Rt Hon John


Howell, Rt Hon David (G'dford)
Pawsey, James


Howell, Ralph (North Norfolk)
Peacock, Mrs Elizabeth


Hughes, Robert G. (Harrow W)
Porter, David (Waveney)


Hunt, Sir John (Ravensbourne)
Powell, William (Corby)


Hunter, Andrew
Price, Sir David


Irvine, Michael
Raffan, Keith


Irving, Sir Charles
Raison, Rt Hon Sir Timothy


Jack, Michael
Rathbone, Tim


Janman, Tim
Redwood, John


Johnson Smith, Sir Geoffrey
Rhodes James, Robert


Jones, Robert B (Herts W)
Riddick, Graham


Kellett-Bowman, Dame Elaine
Ridley, Rt Hon Nicholas






Ridsdale, Sir Julian
Thompson, D. (Calder Valley)


Rifkind, Rt Hon Malcolm
Thompson, Patrick (Norwich N)


Roberts, Sir Wyn (Conwy)
Thornton, Malcolm


Roe, Mrs Marion
Thurnham, Peter


Rossi, Sir Hugh
Townend, John (Bridlington)


Rost, Peter
Townsend, Cyril D. (B'heath)


Rumbold, Rt Hon Mrs Angela
Tracey, Richard


Ryder, Rt Hon Richard
Tredinnick, David


Sainsbury, Hon Tim
Trippier, David


Sayeed, Jonathan
Trotter, Neville


Scott, Rt Hon Nicholas
Twinn, Dr Ian


Shaw, David (Dover)
Vaughan, Sir Gerard


Shaw, Sir Giles (Pudsey)
Viggers, Peter


Shaw, Sir Michael (Scarb')
Wakeham, Rt Hon John


Shelton, Sir William
Waldegrave, Rt Hon William


Shephard, Mrs G. (Norfolk SW)
Walden, George


Shepherd, Richard (Aldridge)
Walker, Bill (T'side North)


Shersby, Michael
Walker, Rt Hon P. (W'cester)


Sims, Roger
Waller, Gary


Skeet, Sir Trevor
Walters, Sir Dennis


Smith, Tim (Beaconsfield)
Ward, John


Speed, Keith
Wardle, Charles (Bexhill)


Speller, Tony
Watts, John


Spicer, Michael (S Worcs)
Wells, Bowen


Squire, Robin
Whitney, Ray


Stanbrook, Ivor
Widdecombe, Ann


Stanley, Rt Hon Sir John
Wiggin, Jerry


Steen, Anthony
Wilkinson, John


Stevens, Lewis
Wilshire, David


Stewart, Allan (Eastwood)
Winterton, Mrs Ann


Stewart, Andy (Sherwood)
Winterton, Nicholas


Stewart, Rt Hon Ian (Herts N)
Wolfson, Mark


Sumberg, David
Wood, Timothy


Summerson, Hugo
Yeo, Tim


Tapsell, Sir Peter
Young, Sir George (Acton)


Taylor, Ian (Esher)



Taylor, Teddy (S'end E)
Tellers for the Noes:


Tebbit, Rt Hon Norman
Mr. David Lightbown and Mr. John M. Taylor.


Temple-Morris, Peter

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

MR. SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved,
That this House welcomes the progressive implementation of the Government's reforms of the National Health Service, coupled with substantial increases in resources for the National Health Service and in the numbers of patients treated since 1979; looks forward to the benefits of these reforms being spread more widely so that services everywhere are brought up to the standards of the best, especially with the further development of National Health Service trusts and fundholding practices; notes that district health authorities and general practitioner fundholding practices will both give priority to patient's clinical needs; welcomes the determination of the new National Health Service trusts to get to grips with long-standing management problems; supports the new role of district health authorities as guardians of the public health, accountable for arranging comprehensive care for their local residents; and endorses the Government's intention to set out a new agenda for the National Health Service which concentrates more than ever on improving the health of the people.

Overseas Aid

Mr. Speaker: I must announce to the House that I have selected the amendment in the name of the Prime Minister. Furthermore, may I say what I said at the beginning of the debate. As many hon. Members wish to participate, I ask not only Members on the Back Benches, but those on the Front Benches, to make short contributions.

Mrs. Ann Clwyd: I beg to move,
That this House believes that the Government's response to crises in Iraq, Bangladesh, and Sub-Saharan Africa has been slow and shamefully inadequate; and calls on the Government immediately to provide additional resources for the Overseas Development Administration to deal with the three current crises and to set a timetable to meet the United Nations aid target of 0·7 per cent. of gross national product.
Over the past few weeks, we have heard much talk about aid fatigue and compassion fatigue. Indeed, with the horror of the disasters appearing daily on our television screens and in our newspapers, it is convenient for Governments to run for cover behind those phrases as an excuse for doing less and less. I am sure that that charge cannot be laid against the Minister for Overseas Development. I know that she is indignant about any suggestion that she is dragging her heels in responding to the great human tragedies of famine, flood and war that have hit our planet.
I know that the Minister dearly wishes that the Chancellor would respond to her pleas to expand the aid budget so that she need not blush every time the Organisation for Economic Co-operation and Development raps the United Kingdom over the knuckles for being so mean. We were not surprised to hear her plaintive cries last week when she told the House that it was time to
seek to make the aid programme grow in real terms"—[Official Report, 8 May 1991; Vol. 190, c. 734.]
She hoped that that would be achieved, but as the aid programme has been stagnant for two years with no real increases planned, perhaps she can tell us today if she would like even more help from the Opposition to enable her to make her case to the Chancellor.
The case for increasing Britain's aid is strong. While the British have been horrified at what they have seen on television and read in newspapers and have dug deep into their pockets, the Government's response to the current disasters has been little short of shambolic. The scale of recent disasters has been exceptional, but the Government's response has certainly not been exceptional. There is no doubt that what has been given has saved many lives, but it has not been enough.
I shall deal with the most recent emergency first. The cyclone in Bangladesh on 29 April was one of the worst disasters in history to hit the region. Hundreds of thousands of people have already died and up to 10 million have been left stranded without homes, land or crops. The United Nations and the Government of Bangladesh have appealed for $1·4 billion—£840 million—for immediate relief, but the total United Kingdom response has been just £6·5 million. The United Kingdom's contribution to the appeal for Bangladesh, based on our share of the gross national product of OECD donors, should be more than £50 million. Last week, the Minister and the Prime Minister claimed that Britain's response was the largest of any donor, but Saudi Arabia has pledged £62·5 million


and now, while our one Royal Fleet Auxiliary ship makes its way slowly to the Bay of Bengal, the United States marines are already there.
In Africa, the situation has been getting worse, and now it is desperate. Twenty-nine million people face starvation in 25 African countries. In total, Africa needs 5·2 million tonnes of food aid, but only 1·4 millon tonnes have arrived. There are just a few weeks left before the rains arrive, making the roads impassable. If the food pipelines are not filled now, millions of people face death by starvation.
The United Kingdom's total famine relief since last September amounts to £67 million, much less than the Overseas Development Administration's drought-related aid to Africa in 1984–85 when 1 million people died. That would be worth £135 million at today's prices.
In its report on the 1984–85 famine, the Select Committee on Foreign Affairs said:
The generosity of the British people has not been matched by the British Government.
If that was true then, how much more true is it today? The problem is that the ODA does not have the cash to cope and the Treasury apparently refuses to give new money.
The Minister will try to assure the House that the ODA's budget is managed flexibly to cope with disasters, but, as the same report by the Select Commmittee on Foreign Affairs states:
The aid budget is designed to have a certain flexibility to enable it to cope with emergency relief. It is not designed to be able to cope with emergency relief on this scale.
Again, if that were true then, it is even more true today.
Not only is the ODA strapped for cash but its existing resources are draining away into the coffers of the Ministry of Defence. In 1984, when the airlift to famine victims in Ethiopia began, the Ministry of Defence paid the full cost. Then the cost was split 50:50 between the ODA and the Ministry of Defence for four months in 1985. In total, the ODA paid £8·3 million of the £21 million that the airlift cost, so why is the ODA now paying the full cost of military relief operations in Kurdistan and Bangladesh? Those costs involve £2,000 an hour for Hercules flights and £2,500 an hour for Chinook helicopter flights. If only the ODA had the clout to send the bill back to the Ministry of Defence.
In Germany, the Defence Department recognises the training value of using the military in civilian disasters. Therefore, the cost is shared between the military's training budget and the aid budget. The British Ministry of Defence's training budget is almost as large as the entire aid programme. The costs should be shared in the same way.
It is clear that the extra £20 million from the Treasury is going straight back into the MOD's pocket. It does not even cover the full cost of the MOD's bill, so the Overseas Development Administration's contingency reserve must be disappearing very fast indeed. As The Independent reported on 6 May, the £20 million was agreed before the Bangladesh cyclone, but the Minister said
she would be pressing the Chancellor for more money this week.
What happened? Did she try? Did she fail? In February, in an interview with The Guardian about United Kingdom famine relief for Africa, the Minister said:
If I needed more money I could go and get it.
Dare she say that again today?
The Minister said that she will have a stronger case for more money when her contingency reserve is all gone, but she cannot afford to wait. Last year she had to tell starving people in Africa to tighten their belts because the kitty was empty and the Treasury refused extra money. It is only the immense political pressure and the horrifying television pictures, along with the personal appeal of Mr. Jeffrey Archer, that squeezed new money from the Treasury for the Kurds. We can all be too sure that when contingency funds are needed next winter for a less politically sensitive part of the world, the ODA will be throwing up its empty hands in despair and the Treasury chest will remain firmly locked.
It is not surprising that the ODA is strapped for cash, because the aid budget has been slashed, as I and many of my colleagues and Conservative Members have said many times in the House. It is still 11 per cent. lower in real terms than it was in 1979. United Kingdom aid, as a percentage of gross national product, fell from 0·51 per cent.—and rising—under Labour in 1979 to 0·31 per cent. in 1989. Despite claims by the Government that the aid programme is growing, it is stagnant in real terms. The planned aid budget for 1993–94 is worth £1·7 billion in today's prices —exactly the same as the aid budget for this financial year.
The ODA's response has been slow as well as small. After the cyclone in Bangladesh, millions of people on flooded land could be reached only by helicopter, yet the ODA loitered for 10 days before even deciding to send four Sea King helicopters on the Royal Fleet Auxiliary ship Fort Grange. They will not arrive for another week or more. When a disastrous cyclone hit Bangladesh in 1970, there was a British amphibious squadron there in just over a week and the Minister—wooden leg and all—was there in under a week.
We knew about the looming famine in Africa last September, so why did the ODA delay over half its aid for this emergency until last month? One reason is that it had run out of money, so it had to wait until the 1991–92 financial year. Another reason is that the Sudanese Government did not publicly admit the scale of the tragedy then, but we should not care whether the Sudanese Government bend on one knee or two to ask for aid when we could be saving starving people.
The ODA lacks not only the cash to cope but the staff, too. Few realise that the ODA's disaster and refugee unit is basically an enabling organisation that signs cheques in support of voluntary agencies. The unit's staff were increased from four to six to deal with the Kurds, and from six to nine a few weeks ago—a sorry contrast to the Foreign and Commonwealth Office's around-the-clock Gulf crisis unit, with 50 personnel. The excellent but overworked staff have simply been unable to co-ordinate all the requests for and offers of aid. The disaster and refugee unit needs extra staff now to screen offers of assistance, filter incoming information and monitor the distribution of aid.
The ODA has also been unable to tap the generosity of the British people. Offers of assistance from doctors, nurses and relief workers around the country have been wasted because the understaffed disaster unit has been unable to process them. Tonnes of clothes have been left in warehouses because the ODA has not had the resources to fly them to the Kurds. For example, due to simple misunderstandings and lack of information, the ODA delayed flying 50 doctors from Cornwall for over a week.
Disasters are not a new phenomenon. Surely the mechanisms for dealing with logistical problems should be in place by now. There should be warehouses of stocks, or a system to tap into commercial stocks. As The Daily Telegraph, in a very good article headed "Emergency Aid —Why we need a force for action"—said:
What has happened in Iraq is that the system has been exposed by the size of the catastrophe … So it is on such occasions that the British Government is exposed as having no system at all. The French have a force, an inter-ministerial committee and a minister.
The article went on:
The Disaster and Refugees Unit is a first class lubricator of the work of the voluntary agencies, who swear by it. But at that level it was never designed to cope with the big emergency. What is needed is recognition on both sides of the House that the British Government does not have a disaster relief system.
The Minister tried to deflect criticism of Britain's response by attacking the United Nations and the European Community, but she is criticising the very agencies that this Government have undermined and underfunded. United Kingdom contributions to nearly all the United Nations development agencies have been cut by this Government. Funding for the United Nations Development Programme has fallen by 52 per cent. in real terms since 1979. On 9 April, the United Nations High Commissioner for Refugees appealed for $238 million for Iraqi refugees, but one month later less than $100 million had been pledged. According to the UNHCR, every cent has been spent or committed—usually before the ink was dry on the cheque. The United Kingdom's contribution of $95,000 was the lowest of all.

Sir Philip Goodhart: Does not the hon. Lady acknowledge that our contribution to the main UNHCR fund last year was the sixth largest of any country—that it was twice as large as that of France, four times larger than that of Italy and larger than that of Germany?

Mrs. Clwyd: That does not negate the point that I was making. If one looks through the list of United Nations agencies, one finds that in almost every case—the United Nations International Children's Emergency Fund, UNDP and others—the British Government's contribution has been cut drastically. The United Nations High Commissioner for Refugees said, "We can do the job. Give us the money." Therefore it is totally unfair for the Government to criticise UN agencies when they are not prepared to give them the money to do the job. As Mrs. Ogata said:
The UNHCR is not able to mount massive relief operations on credit. If further special allocations are not made immediately, the entire humanitarian effort will be in dire jeopardy.
In the case of the European Community, I understand that it was the British Government who led the discussions to reduce the European Community's special food aid programme for Africa by 20 million ecu. It is the Council of Ministers that refuses the Parliament's request to establish a permanent emergency aid reserve chapter in the EC's budget.
I have already outlined the immediate need for new money for the aid budget, for more emergency relief and for more staff in the disaster unit, but there is much more that must be done in the coming months and years. After the immediate relief effort, the next priority will be aid for reconstruction. The victims of famine in Africa and of the

cyclone in Bangladesh need seeds, tools and cattle if they are to plant anything for the next harvest. The economy of Bangladesh has been devastated. The Bangladeshi Government have made it clear that the appeal for $1·4 billion is for immediate relief needs only and that there will be further appeals for reconstruction aid. Will that be forthcoming?
Before the next disaster strikes, the ODA's disaster unit must be revamped. It needs contingency plans to expand, with suitably experienced staff being available as soon as a major disaster breaks. Regional co-ordinators should be found to co-ordinate donations on behalf of the ODA during disasters. An ODA internal evaluation of the response to famine in Africa from 1983 to 1986 found that there had been little contingency planning by the ODA for such a large-scale disaster. It said that more staff were needed and that staff were too busy to monitor the implementatoin of relief efforts funded by the ODA or to plan ahead. It recommended training for members of the disaster unit. Have any of its recommendations been implemented?
Gales strike the coast of Bangladesh every day. Gales and cyclones will kill thousands more unless there is adequate investment in early warning systems and cyclone shelters. About 4,000 cyclone shelters are needed, but at present there are only 350. Our bilateral aid programme to Bangladesh is one of the largest. It should support a strategy for disaster prevention in future. In Africa, aid should be invested in early warning systems, with regionally held food stocks, transport systems and other measures to prevent a drought from becoming a devastating famine.
A mobile emergency volunteer force is needed. Doctors, engineers and other experts who volunteer to assist in times of emergency should be sent immediately to where they are needed; hence, selection and co-ordination must occur in advance. In Switzerland, disaster relief units can second experts for two to three months and emergency teams co-ordinate with the United Nations. In France, Medecins Sans Frontieres was working with the Kurds on Iraq's borders within days of the exodus.
Some mechanism must be found to tap the skills of British experts and to ensure that emergency relief reaches those in need as soon as possible. The Government should either set up a state-funded register of experts, as in Switzerland, or ensure that non-governmental organisations can afford to retain experts who can be sent out at short notice. We already have a capable disaster relief squad in the armed forces. The new international climate makes in impossible for the armed forces to be more involved in civilian as well as military emergencies, as The Daily Telegraph wrote:
The forces' stock in trade is getting there 'fastest with the mostest' and nobody does it better.

Mr. James Paice: I hope that the hon. Lady will refer to the part of the motion which calls on the Government
to set a timetable to meet the United Nations aid target of 0·7 per cent. of gross national product.
What timetable would she wish to set, and what timetable would a Labour Government set?

Mrs. Clwyd: I shall send the hon. Gentleman a copy of the relevant section of our manifesto. We have promised


that the next Labour Government, not now long awaited, will increase our percentage of GNP to 0·7 per cent. within the first five years of taking office.
United Nations agencies, particularly the disaster relief organisation, should be strengthened. Ministers, including the Prime Minister, are talking about the need for a new international agency for disasters. What do they intend to do about that? The right hon. Member for Bath (Mr. Patten), the Chancellor of the Duchy of Lancaster, talked of precisely that when he was Minister for Overseas Development in 1988.
I remind the Government that the United Nations Disaster Relief Organisation already exists. We should strengthen that existing organisation before inventing new agencies. Once the United Nations agencies are assured of sufficient cash to operate effectively, it will be worth reviewing their mandates to strengthen their roles. In particular, we must ensure that they can meet the emergency needs of people displaced in their own countries, as well as those of refugees who flee abroad.
The root causes of disasters, particularly conflict and poverty, must be tackled. Resolving bitter conflicts and civil wars is the only long-term solution for Africa, just as peaceful autonomy is the only solution for the Kurds. There are signs of hope, such as the recent agreement between the Angolan Government and UNITA for a ceasefire and elections. But all peace negotiations need to be underpinned by the international community through the United Nations. The richer members of the United Nations must be willing to give it the clout and financial resources to monitor and guarantee the peace process in Angola and elsewhere.
Poverty turns a drought into a famine or a cyclone into a human tragedy. Poverty forces millions of Bangladeshis to eke out a living in paddy fields on flood-prone lands. One of the poorest countries in the world, Bangladesh cannot possibly afford to build 4,000 cyclone shelters or spend 6 per cent. of its GNP on sea defences, as the Dutch do.
Action Aid's report on British aid to Bangladesh in 1988 found a massive shift from project to programme aid and increasing commercialisation of aid. It reported that little was spent on projects directly benefiting the poor. Long-term sustainable development is ultimately the best way to prevent disasters. Radical action is needed to alleviate the poverty of 1 billion people and to reduce the debt burden that is keeping third-world countries poor. Action to prevent global warming is vital, too, if storms are not to become more violent and frequent. As Prince Sadruddin Aga Khan said on 5 May:
Unless you have some kind of new economic order, people will continue to move North: all the barbed wire, laws, and immigration controls in the world—nothing will prevent that.
A new economic order means debt relief, improved trade, more aid and a massive investment by north and south to eradicate poverty. Sadly, the British Government are not promoting such an economic order. We should lead the way forward at the G7 summit in London in July by launching an attack on poverty and debt, and if the Prime Minister has the nerve to call an election in June, the new Labour Government will do exactly that.
If the British Government are committed to alleviating poverty and promoting sustainable development, they

know well the next step to take. It is to set a timetable to meet the United Nation's aid target of 0·7 per cent. of GNP.

Sir Peter Blaker: rose—

Mrs. Clwyd: I hope that the right hon. Gentleman will forgive me for not giving way. I am bringing my remarks to a close.
The United Nations is more entitled to criticise the British Government for taking Britain away from the United Nations aid target than the Minister is entitled to batter the United Nations for its failures. I cite these examples of the Minister's criticisms of the United Nations:
I am concerned about the lack of speed of the United Nations in dealing with the problems … In the meantime, there is much work to be done in providing relief. In that sense, the United Nations must get its act together … We want an effective United Nations reaction, but it is taking a long time to get up and running".—[Official Report, 22 April 1991; Vol. 189, c. 777–82]
Those are exactly the criticisms that we make of the British Government. Could it be that the Minister is looking for a scapegoat? Is it not a fact that she and her Government colleagues have lacked speed, that they should get their act together and that they need to get up and running? Perhaps they are suffering from fatigue—the fatigue of a tired and worn-out Government.

The Minister for Overseas Development (Mrs. Lynda Chalker): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
'welcomes the Government's swift and continuing generous responses to the crises in Iraq, Bangladesh and Sub-Saharan Africa; and also welcomes the Government's initiatives to ensure the continuing effectiveness of United Kingdom aid and to stimulate improved international disaster relief delivery.'.
No one can look back on the vivid images of recent weeks without being moved by the suffering of so many fellow human beings. In the Gulf region, we have seen Iraqi refugees trekking into inhospitable mountains and across national boundaries to escape one man's tyranny. In Bangladesh, whole communities have been swept away by natural disaster. In Africa, a devastating combination of natural and man-made disasters threatens life on a scale at least as great as any that we have seen.
I am sorry that the hon. Member for Cynon Valley (Mrs. Clywd) chose to put her case as she did.

Mr. D. N. Campbell-Savours: The Minister is reading, so how can she say that?

Mrs. Chalker: If the hon. Gentleman wishes to intervene, I will give way, but it is a little early in the debate. I am not reading; my remarks are not on the brief in front of me.
I particularly regret the hon. Lady's use of the words "slow" and "shamefully inadequate". I believe that she does not mean the words to be accurate or descriptive but uses them for effect, like the absurd claim made last week that the Government have a "secret agenda" for raising VAT. Although the subject of Labour's motion is aid, the context is its ongoing and futile election campaign.

Sir Peter Blaker: The House heard the hon. Member for Cynon Valley (Mrs. Clwyd) read out the proposals that the Labour party has just made for reaching the United


Nations target of 0·7 per cent. of GNP. Is not that exactly the same promise, almost word for word, that the Labour party made in 1974? Will my right hon. Friend the Minister tell the House how many times, in the 17 years that Labour has been in power since the second world war, a Labour Government have reached that figure?

Mrs. Chalker: My right hon. Friend makes a valid point. Labour Governments have always accepted the 0·7 per cent. of GNP target, but in none of those years did they reach it. I do not blame the hon. Member for Cynon Valley for that, because we have not reached it either. However, we have no chance of reaching it unless we have proper economic growth, and we have proper economic growth only when the economy is properly managed. It was proved in 1976 and 1977 that we shall never have that under a Labour Government.

Mr. Max Madden: Will the Minister take a second to compare the pitiful number of journalists reporting this debate in the Press Gallery with the much larger number of men and women in the Public Gallery? The British public are greatly moved by what they have seen on their television screens in recent months in Africa, Bangladesh, Iraq and Iran. I would be prepared to have a small wager with her that most people would be prepared to forsake any tax cuts that the Government may make for a positive promise to deliver what they want—a war on the poverty that they see throughout the world today. I hope that, in what remains of the debate, the Minister will say how the Government will deliver that commitment rather than play around with party politics in a pre-election campaign.

Mrs. Chalker: The hon. Gentleman's last words reveal exactly what he is about.
I wish to deal with the real world disasters that we now face. They are global in nature and demand a global response. I am proud of the part that Britain continues to play in our work overseas and to be associated with the efforts of the many people currently engaged in the British aid effort, whether it is in humanitarian terms, such as emergency relief, or in the regular development programme. That includes all my officials, the non-Governmental organisations, volunteers and hundreds more besides, many of whom have worked the longest weekday hours that I have every known and nearly every weekend since the end of March. I am deeply grateful to them. They have done it willingly—they have not been press-ganged into it—and they have had increased support as the weeks have gone by and new disaster has come upon new disaster.
Before I speak about the major elements of our response to disasters, I shall say a few words about their causes. At first sight, there may seem to be little that we can do to prevent the droughts and cyclones that have afflicted Africa and Bangladesh. However, underlying their impact are factors such as population pressure and poverty. which the hon. Member for Cynon Valley mentioned. We continue to tackle those through carefully targeted development aid. That is why I announced increased population planning grants for the International Planned Parenthood Federation and the World Health Organisation. When I saw Dr. Sadik, the executive director of the United Nations Fund for Population Activities yesterday, I announced a 25 per cent. increase to £7·5 million.
We are also working in Bangladesh—which has been so sorely hit by the awful cyclone and the subsequent bad weather—with the World bank and other donors to put in place one of the largest population projects ever established, worth over $600 million, £12 million of which is the United Kingdom's contribution. We have been seeking to focus our work on poverty, particularly in the Asian countries, and 70 per cent. of British aid is going to the poorest countries in the world. I agree that poverty must be a key focus in our aid programme but we are carrying that through in our regular development programme and shall continue to do so.

Sir Charles Morrison: My right hon. Friend's remarks about the increased aid for the population programme are welcome, but will she do her best to encourage other nations, particularly the United States of America, to follow suit? Their record in recent years is disgraceful.

Mrs. Chalker: My hon. Friend makes a valid point. We have already been working with other donors to try to make them increase their contributions on population planning. I hope that they will listen because we firmly believe in a constructive mother and health care programme, which can best be achieved by sensible family planning schemes throughout the world through bilateral and international programmes.
It is less easy to tackle the scourge of war, which is one of the other main problems affecting many developing countries. Those wars have contributed so much to the tragedy of Africa. There are signs of progress and we welcome, in particular, the preliminary ceasefire agreement in Angola and the talks to be held in London next week between the Ethiopian Government and opposition groups. Sadly, there are fewer signs of optimism for the people of Sudan, Somalia and Liberia, who still face fighting day in and day out. I assure the House that the Government will continue to work strenuously for peaceful solutions to all Africa's conflicts.
We must encourage good government in the developing countries. It is important not only for human rights but because good government, sound economics and free markets are essential if people are to feed themselves and corruption is to be rooted out. The hon. Member for Cynon Valley will agree that that is one of the key problems to be resolved. I was sorry that I could find no room for good government in the Labour party's latest policy document, "Opportunity Britain".
Donors should encourage developing country Governments to stop fighting endless civil wars. The Governments of those countries should let their farmers get on with trying to grow their produce and selling it in a peaceful and free market.

Mr. David Alton: The right hon. Lady will recall that, while she was absent on a trip to the Horn of Africa, one of her colleagues at the Foreign Office assured the House that funds would be made available for transportation in the Horn of Africa. The hon. Lady will know that some money has been made available, but the major aid agencies, in particular Christian Aid, say that Hercules aircraft are still not flying and transportation has not been provided. Can she tell the House anything about that?

Mrs. Chalker: All the food aid sent to Africa by this country has been accompanied by covering transport costs. I have made it a policy that when we give food aid, we must ensure the means of its arrival at the proper destination. I hope that the hon. Gentleman will agree that we have been seeking to plan ahead. There have been many problems in Sudan. I only hope that, since the arrival here of the Sudanese Minister of Finance, with whom we had some vexed words, a little more progress is being made in Sudan. The Sudanese Government have at least begun to talk about the size of the problem faced by Sudanese people.
It is not enough for disaster relief to be swift: it must also be effective. We heard a lot from the hon. Member for Cynon Valley about slowness. However, when dealing with such disasters, in addition to consultation with the relevant Governments, other donors, the international relief agencies and our own non-governmental organisations, we also need to ensure that all those factors are brought together. That means that not only we, but other donors, must be ready to dispatch the right assistance.
Sadly, there have been far too many examples of over-stretched transport facilities, clogged up with well meant, but unwanted, relief items, and of well-intentioned volunteers who have been prevented by the authorities overseas from joining the relief effort. The hon. Lady mentioned that, and I want to mention the problems that have occurred in Turkey, Iran and Iraq, where second-hand clothing, willingly donated by so many people, was turned back as unacceptable. That may seem strange, but we have to pay the cost of transporting the clothing, and if it is turned back as unacceptable it is obvious that we would have been better off using the money for other purposes. It is very sad that thousands of tonnes of unwanted clothing were sent overseas.
In the early days of the Iraqi refugee tragedy, there were people from other countries—not this one—hanging around airports in Turkey and elsewhere who were unable to leave and provide the help they wanted to give because they were not permitted to leave. All our volunteers have gone to the camps and places where they can help. That was why I insisted on careful planning, preparation and consultation in the country of the disaster to ensure that the donor assistance reached its target. None of those priorities seems to be reflected in the Opposition's approach.

Mr. Tam Dalyell: Will the Minister give way?

Mrs. Chalker: This is the last intervention that I shall take or I shall not be able to respond to the debate.

Mr. Dalyell: Will the Minister consider the situation of some Iraqi students at universities such as the Heriot Watt, which is now desperately short of funds. Those students are precisely the sort of people that would be useful in future in a rebuilt Iraq.

Mrs. Chalker: I am sure that if those people are willing to volunteer, they will be considered along with the many others who have done so.
I am also sure that we are right to ensure that the contributions that we make, whether to the United Nations or anywhere else, are well targeted. Earlier this year, before the Kurds, Shias and others left their homes, the Overseas Development Agency contributed £8 million

to the United Nations agencies to meet the expected refugee outflows from Iraq. But as we now know, those plans were overwhelmed by the sheer flood of refugees towards Turkey and into Iran. At that time, the United Nations expected about 400,000 refugees to come into Iran, Turkey, Jordan and Syria, but in truth, more than 2 million refugees have crossed the borders into Iran and Turkey.
In the seven weeks since the human trek to safety began, the ODA has committed a further £62 million in humanitarian aid to Iraqi refugees, in addition to the special contribution being made by British troops. I shall return to the issue of Ministry of Defence costs later. The sums committed since Christmas, which total £70 million, are by any measure a substantial response to the needs of the Iraqi people.
We have flown more than 1,000 tonnes of tents, blankets, food and medicine into Turkey and Iran by cost-effective commercial flights. We used the RAF's Hercules and Chinooks to deliver that aid to the people in the mountains and on the roads, often in the most appalling conditions. So far, we have spent £6·7 million on the air bridge in Iraq, Iran and Turkey, £5 million of which is the additional cost of using MOD equipment.
We have financed the activities of British NGOs. Last week, 91 volunteers with medical, nursing and rescue experience went to provide every assistance to the refugees still in the mountains and help them make their difficult journey south and west to their towns in Iraq. More volunteers will follow them to carry through the work and extend their excellent contribution to the Iraqi people. I know that the hon. Member for Cynon Valley thought that that should have happened sooner, but it is no use saying that when planning is dependent on the position at the other end, as well as those who come forward and the preparations that are made.

Mr. D. N. Campbell-Savours: rose—

Madam Deputy Speaker (Miss Betty Boothroyd): Order. The Minister has made it clear to the House that she will not take any more interventions.

Mrs. Chalker: I have indeed, Madam Deputy Speaker, so as to allow as many speakers as possible to contribute to the debate. I have taken more than six interventions already.
Britain has led the international efforts to find a long-term solution to the crisis. It was our Prime Minister who willed the creation of safe havens in northern Iraq. From the beginning, British troops have been involved in the establishment of those havens. There is still much to be done—[Interruption.]

Madam Deputy Speaker: Order. The hon. Member for Cynon Valley (Mrs. Clwyd) was heard in good order. I hope that the same courtesy will be extended to the Minister.

Mrs. Chalker: There is still much to be done, but I know that the House will be encouraged by the fact that refugees are now coming down from the mountains and moving into the safe areas in substantial numbers. That same process is also beginning to happen from parts of Iran. The UN's role is now developing in Iraq. To help that operation get under way, I announced Britain's contribution of $10 million to UN humanitarian relief for the region early last week.
In Bangladesh, Britain has led the relief effort. Our initial response of £6·5 million was one of the first and, then, the largest. More has since been added by countries such as Saudi Arabia, but that country has pledged its money not for immediate relief, but for reconstruction. One needs to look at the detail of what has happened.
In Bangladesh we financed the urgently needed supplies of tents, blankets, food and medicine, as well as tackling the appalling disruption of communications by paying for a Royal Fleet Auxiliary, with four helicopters with substantial disaster relief stores, nine boats and a detachment of Royal Marines. ODA vehicles are in use in the flooded districts and boats, including some from the Royal National Lifeboat Institution, are distributing food when the weather permits.
Britain has financed two United Nations disaster relief experts in Chittagong from the beginning of the crisis. As always, we are working with British and local NGOs, who are doing a magnificent job to deliver relief to those in need. Our NGO co-ordinator from Dhaka set up an office in Chittagong a week ago to provide on-the-spot assessments and ease co-ordination among aid organisations locally.
However, it is in Africa that 29 million people face the worst disaster. The continuation of drought, long-running civil wars and economic mismanagement have worsened the crisis of starvation and illness. Britain's response has again been swift and substantial. The £90 million pledged by ODA since last September includes 158,000 tonnes of bilateral food aid, much of which is for the horn. That makes Britain the second largest contributor of food to the region. Britain will continue to play her part, but we need other donors to contribute too. That is why, for more than six months, I have strenuously pressed for more urgent action for Africa by other donor countries and the European Community. More than 800,000 tonnes of food will now be financed from the Community budget, with more to follow from other member states. But the crisis in Africa is a long way from being over. Our job over the next few months will be to continue to save lives and give people the means by which they will be able to feed themselves in future.
I now come to the financing of aid. We have heard more than enough carping about money from the hon. Member for Cynon Valley in recent weeks. We have also heard a lot about targets. The Government remain committed to the principle of the United Nations aid target, but I shall not attempt to compete with the hon. Lady to see who can promise to spend the most. Spending money for the sake of it is easy. Making that money really effective where people need relief is another matter.
We started this financial year with an aid budget of £1,721 million. It is a substantial programme—the sixth largest in the world. Its value has grown in recent years and it is planned to continue to grow in real terms. Our aid is well targeted and effective. Its quality and professionalism are praised by the OECD's development assistance committee and by the Select Committee on Foreign Affairs.
We provide humanitarian relief without diverting resources from our planned development programmes, because humanitarian relief comes from funds set aside for that specific purpose, calling as necessary upon the Overseas Development Administration's in-year contingency reserve. In exceptional circumstances, we also have recourse to the Treasury reserve.
My right hon. Friend the Prime Minister made it clear in a letter to the Leader of the Opposition, in the context of our efforts to help Iraqi refugees, that the Government were prepared to look sympathetically at the case for making additional resources available to the ODA for humanitarian purposes if it looked as though its contingency reserve was likely to be exhausted early in the year.
As the House knows, on 29 April the Prime Minister announced an extra £30 million for the aid programme for continuing assistance to Iraqi refugees. I had no hesitation then about going to the Treasury for that additional money, and I do not hesitate to do what needs to be done. I can assure the House that the Government will continue to look sympathetically at the resources available to the ODA so that Britain can continue to play its full part in the international relief effort to help alleviate the terrible suffering in Africa, and to assist the people of Bangladesh to reconstruct their lives. This afternoon in Brussels EC Foreign Ministers agreed a further 60 million ecu package of co-ordinated assistance to Bangladesh in addition to the initial relief contributions already announced. We are glad to contribute to that.
It is clear that the armed forces constitute a key element in our disaster relief capability. Let me make it clear to the hon. Member for Cynon Valley that the aid programme pays only the extra costs—of fuel and spare parts, for instance—arising specifically from the humanitarian relief operations carried out on our behalf by the armed forces. Our armed forces are doing a magnificent job in Iraq and in Bangladesh, and we applaud them for all that they do. But it is not for Britain alone to provide all the relief, money and solutions. The problems are international and they need international solutions. It is clear that every nation and group of nations must play its full part in a co-ordinated way.
Britain galvanised the EC's decision to provide additional substantial disaster relief—105 million ecu in the case of Iraqi refugees and 115 million ecu for famine relief in Africa in recent weeks. However, it is the UN which should play the unique role of co-ordinating the international response to disasters. I agree with the hon. Lady that the UN disaster relief organisation is good, but it is very small.

Mr. George Foulkes: It lacks money.

Mrs. Chalker: It has had resources and it will continue to have resources. I look forward to the UN takeover of the relief operations in northern Iraq. We want that to happen, but the transfer must be worked out. That is why discussions continue in Baghdad. A UN resolution may be necessary to achieve that end, but we believe that it is right for the UN to prepare to take on that role in the safe havens in northern Iraq.
I pay tribute to the International Committee of the Red Cross for its outstanding role in the humanitarian aid operations. It has been backed up well by Red Cross and Red Crescent societies, and many other agencies. We applaud their efforts, but it is still the UN which must play the unique role of co-ordinating the international response.

Mr. D. N. Campbell-Savours: Will the right hon. Lady give way?

Mrs. Chalker: No, I have made it clear that, because of pressure of time, I shall not give way.

Mr. Campbell-Savours: rose—

Mr. Deputy Speaker (Sir Paul Dean): Order. The Minister has made it clear that she is not giving way. This is a very short debate.

Mrs. Chalker: There is much to be proud of in both the British and the international provision of humanitarian relief, but we must continue to adapt and improve our response mechanisms.
At the international level, only the UN has the power and resources to mobilise the international community, but too often it has been hamstrung by a lack of clear leadership and co-ordination. Institutional improvements and changes in attitude are needed. The UN must lead and co-ordinate the international response to international emergencies. We believe that the time is ripe for reform. We have been discussing that idea with other like-minded countries. As my right hon. Friend the Prime Minister informed the House on 9 May, we want better international co-ordination of emergency assistance, and we are doing all that we can to bring it about.
We must also ensure the effectiveness of Britain's disaster relief system. In the past, the ODA has worked mainly through non-governmental organisations and other international agencies. They have the skills and experience to deliver effective relief on the ground. Our work has therefore involved the allocation of funds rather than the direct management of relief operations. A small disaster unit was adequate for that purpose, but the nature and extent of disasters have changed dramatically in recent years, and so have our responses. We have become more directly involved in the management of the responses. Increasing use of the armed forces is one aspect of that development. Another is the organisation of teams of volunteers to work in refugee camps such as those on the Turkey-Iraq border. In order to manage such operations, we have strengthened the disaster relief unit and its staff has been doubled. There is now a basic staff of 12.

Mr. Campbell-Savours: Four, six, nine, and now 12.

Mrs. Chalker: The hon. Gentleman may shout as loudly as he likes, but it is not simply that the number of staff in the unit has been doubled. The rest of the staff in the office are there when their expertise is needed to back up the disaster relief unit. If the hon. Gentleman believes that maintaining a standing waiting capacity in a unit that would be used only from time to time is using scarce aid funds effectively, he has got it wrong.
Putting extra staff into such a unit is only one aspect of the challenge. The management of our disaster relief has already been under review. We shall strengthen our operations system by maintaining a permanent register of volunteers from this country with appropriate skills and experience. The first stages of that initiative have already been set up and have been used. That register will continue to be used because the volunteers will give us the capacity to mobilise multi-disciplinary relief teams at short notice.
I understand the frustration of some hon. Members. I understand their mood, but one thing that I know above all is that the value of the humanitarian aid that Britain has been providing and will continue to provide is second

to none. There are a great many dedicated people both inside and outside Government who make that possible. We intend to make their efforts even more effective.
The Opposition motion is misconceived—it is a disgrace, and I ask the House to reject it.

Mr. Peter Shore: I shall be brief, not because the subject invites brevity but because many hon. Members want to speak in the debate.
This has been a year of exceptional disaster for millions of people in Africa, Asia and the middle east. The effects of three great calamities are with us. The first is the plight of nearly 2 million Kurds and 500,000 Shi'ites who fled from their homes in Iraq to the border areas of Iran and Turkey. The second is the ever-increasing threat of famine for millions of people in the Horn of Africa and Mozambique. The third is the violent cyclone that engulfed the islands and coastal area of the bay of Bengal only a fortnight ago.
On Thursday, the Select Committee on Foreign Affairs was given the welcome news that the two helicopters on the Royal Fleet Auxiliary Fort Grange had been increased to four. The news about that had been given the day before by the Minister for Overseas Development. I also understand that five American helicopters and four additional ones from India have arried in Bangladesh. That will greatly augment the capacity of the Government of Bangladesh and the relief agencies there to deliver essential supplies to the scattered communities on the islands and in the flooded areas around the bay of Bengal.
Unhappily, we have not yet seen the end of the calamity in Bangladesh. Since the great cyclone, a tornado has hit part of Dhaka, the rivers have flooded around Sylhet, and a second cyclone is reported as moving up from the Anderman islands area. The short-term measures that are now in hand to rescue people from starvation and disease from only the first part of a crisis programme. As my hon. Friend the Member for Cynon Valley (Mrs. Clwyd) made plain, the cyclone and its floods destroyed crops, drowned livestock, wrecked boats and severely damaged the infrastructure in the Chittagong area. Millions of people have been severely affected, and well over $1 billion-worth of damage has been caused.
Because of the poverty and shortage of resources, neither the Government of Bangladesh nor the people there can supply the seed, the livestock, the shelter and the boats that are required to rebuild their shattered lives and communities. That will make continuing demands on our emergency aid programme.
Inevitably, the budget of the Overseas Development Administration has been overwhelmed by the demands of those three crises, and its contingency reserve of about £70 million has already been used up or is certainly well committed. Of course there will be a generous response from people all over the country, and especially from the Bangladeshi communities, to the call for aid funds. However, if we are to make a continuing and effective response, further funds over and above the £30 million that I understand the Treasury has already committed will be necessary, and will have to come from the Government's contingency reserve. I am glad to have the right hon. Lady's assurance that she will press for extra funds, because they will undoubtedly be needed.
We should consider, however briefly, not only the immediate crisis but the longer-term measures that are needed to prevent or at least to mitigate similar disasters. There is no doubt that the cyclone shelters, pitifully inadequate in number though they were, were highly effective in preserving lives. However, I am told that none has been built since 1978. Following the great floods in September 1988, flood action plans have again been drawn up by the World bank. The United Kingdom has played a considerable part in drawing up those plans, but their execution, apart from the great embankment at Dhaka, has scarcely begun. If we are to avoid similar catastrophes in the years ahead we must increase our aid budget and must target it more effectively on life-saving projects.

Mr. Bowen Wells: Surely the responsibility for building life-preserving shelters in Bangladesh is primarily that of the Bangladesh Government. The right hon. Gentleman will know about the nature of Bangladesh Governments in the past and will know that offers of help were met with resistance and obstruction. The international community, and especially Britain through its aid budget, encountered great difficulty in trying to set up such shelters. Does the right hon. Gentleman agree that we should tell the Bangladesh Government that the erection of such shelters should be given priority, and that it is being done on their behalf?

Mr. Shore: Plainly, the Bangladesh Government have to be the major partner in all efforts to tackle the enormous problems in Bangladesh. Unfortunately, Governments in Bangladesh have been not only administratively inefficient but lacking in accountability to their people because they have been established either by martial law or by rigged elections. Bangladesh has just had, for the first time, a free election which produced a Government who are genuinely representative of the people of Bangladesh. That Government were at once overwhelmed by the tragedy of a great cyclone disaster, and that must earn them rightly deserved sympathy.
Our aid programme has dropped far below the United Nations target of 0·7 per cent. of GDP, which we accepted many years ago. If there is to be a peace dividend from the end of the cold war—as, in time, there will be—there is an overwhelming case for our overseas aid budget having the first claim upon it.

Sir Philip Goodhart: The right hon. Member for Bethnal Green and Stepney (Mr. Shore) has made a typically constructive speech, which I am sure commands the support of the whole House. The hon. Member for Cynon Valley (Mrs. Clwyd), who opened the debate, adopted a rather more partisan approach. I am sure that historians will applaud the role of our Government and country in bringing help to the Kurdish refugees in particular.
Under the terms of the United Nations resolutions that formed the basis of our participation in the Gulf conflict, we could not intervene until the Kurds were in flight. There was therefore an unavoidable delay in giving them assistance, but, even allowing for that, the dominant impression that many of us will retain from watching the pictures of the earliest relief efforts is one of avoidable confusion and muddle. That pitiful confusion must raise the question why we do not have a properly organised,

Government-supported disaster team that can fly out at short notice to give help when there is a natural or a man-made disaster.
The needs of suffering people are usually the same, whether they have been afflicted by hurricanes, earthquakes, or a breakdown of law and order. They need medical care and drinkable water, and they need communications, so that those who are trying to cope can tell the extent of the disruption and can find out what is going on.
Our armed forces have transport aircraft that can get the right people and the right equipment to the scene of a disaster. The medical services of the armed forces have doctors and nurses who are trained to cope with the casualties of disaster. We have service engineers who are capable of dealing with water problems, and signalmen who can provide the communications that are needed. What we do not have is the system of getting the right people to the right place with the right equipment.
Why do not we have a proper disaster response system? It is not because there is a shortage of ideas. The hon. Member for Cynon Valley quoted freely from an article in The Daily Telegraph by my friend Hugh Hanning of the Fontmell group on disaster relief. He has produced so many practical ideas, and has been churning them out for years.
The ideas of the Fontmell group have been enthusiastically greeted within the armed forces, and similarly by hon. Members on both sides of the House. Indeed, they were cheered by Members of the extreme left and the centre left only a few moments ago. They also have the widest support among the centre right and the far right on the Government Benches.
Why has not more happened? I suspect that the answer is a degree of bureaucratic inaction. Many civil servants, as Sir Bernard Ingham has forcefully reminded us in the past day or two, have considerable energy and imagination. I suspect, however, that the civil servants who man the relevant departments in the Ministry of Defence and who deal with these problems are not equipped with the same imagination and energy. As the hon. Member for Cynon Valley said, they have been a mite too bureaucratic in recent years in charging the Overseas Development Administration rather more than it should have been charged for services rendered.
The ending of the cold war and the restructuring of the armed forces implicit in "Options for Change" mean that the Government have every excuse for reconsidering the creation of a proper disaster relief team that would combine civilian and service personnel. I am glad that the steps will be taken that my right hon. Friend the Minister announced a few moments ago. Sadly, it seems certain that the number of refugees in the world will increase rather than decrease in the years to come. The most acceptable quick fix for dealing with the desperate needs of refugees must be to strengthen the resources of the United Nations High Commission for Refugees.
In the past, the Government have been understandably critical of the competence of some United Nations agencies, but the UNHCR is putting its house in order and is short of cash rather than competence. Like the hon. Member for Cynon Valley, I do not believe that we have any reason to be ashamed of our record in the support of the UNHCR over the past decade. Last year, we were the sixth largest contributor. We provided more funds than Germany did, twice as much as France and four times as


much as Italy. If the western world is to begin to cope with the refugee crisis, however, with the flood of refugees in Asia and Africa, the resources of the UNHCR must be increased. I do not believe that it is starry-eyed or idealistic to think of doubling the funding for the organisation during the coming year.
We are good at responding to special appeals, but I was saddened yesterday to receive a letter from a Foreign Office Minister—not my right hon. Friend the Minister of State—that told me that our contribution to the general fund of the UNHCR at the end of the coming year, at £20 million, would be the same as that made this year. I think that we should at least double our contribution, and that we should lead a campaign to encourage other rich nations to increase their contributions as well.
Finally, I make no excuse for returning to the problem of the Vietnamese boat people in Hong Kong. Hong Kong is the only place in the world in which large camps for refugees and asylum seekers are maintained on British territory. I know that the administration of the camps is a continuing source of friction and ill will between the Hong Kong government, the UNHCR and the British Government. Nominally, the camps are run by the UNHCR, but in fact it does not have the funds to do a proper job. Most countries do not contribute to the UNHCR operation in Hong Kong. They specifically exclude Hong Kong, because they believe that Hong Kong is a comparatively rich territory that does not need help.
America has provided more than half the funds for the UNHCR for use in the Hong Kong camps. Japan and the European Community together contributed half as much as the United States. The only other significant help has come from Australia, Canada and Sweden: their combined contribution amounts to one quarter of the American funding.
The burden on the Hong Kong Government has been increased and, in the run-up to the elections in Hong Kong in the autumn, the members of the Legislative Council are saying that they will not provide funds for any new accommodation. On the other hand, the number of people coming from Vietnam, which showed a marked decline last year, is increasing. That is why the Vietnamese Government face severe economic and political problems at home.
The existing camps are intolerably overcrowded, and thousands of young Vietnamese boys and girls are spending their entire childhood locked inside crowded barbed-wire compounds, with rudimentary schooling and no chance of touching, or even seeing, a flower or a tree. I understand the problem we face, and I also understand the Government's reluctance to become directly involved, but we can and should make a greater contribution to help those who are the true victims of compassion fatigue.

Sir David Steel: I preface my few remarks by saying that I agree so much with the tenor of the speech of the hon. Member for Beckenham (Sir P. Goodhart), and especially his reference to the work of the United Nations High Commission for Refugees, which is one of the better United Nations agencies. It is one of the more effective, yet it is sorely pressed for funds. I agree especially with the hon.

Gentleman's remarks about the refugees from Vietnam. Having seen one of the camps for the Vietnamese boat people in Hong Kong a few months ago, I hope that the hon. Gentleman's words will fall on receptive ears.
It is easy for Opposition parties to say in a debate of this sort that the Government are too slow to act and that they do not give enough in response to disasters. I have a feeling that we would say the same whatever the Government did—so let me get over that at the outset by saying that I too think that they have acted too slowly and given too little.
Mr. Speaker has appealed to us to make short speeches. I wish to make five points, which I hope will be constructive, about the structural lessons to be learned from disasters; if I can make them all in one minute, I shall be extremely pleased.
First, I agree with the hon. Member for Cynon Valley (Mrs. Clwyd) about the need for the Government to set a general target for their overseas aid budget. One improvement has already been made. The previous Prime Minister never accepted such a target in principle; she never allowed any reference to the 0·7 per cent. figure to escape her lips. Indeed, she always argued that there was a great role for trade and the private sector. I do not deny that, but it is none the less welcome that the new Prime Minister should accept that the 0·7 per cent. target is desirable.
My party is committed to supporting that target within the lifetime of the current Parliament, and we have heard that the Labour party is as well. It would be very pleasant if an all-party consensus could be reached, with the Conservative party putting a date to the target. It would not matter very much if we failed to meet it; if we established an aim, we could at least come back every year and complain that it had not been achieved. Let me make a serious point: we might then move towards the target rather than moving away from it, as we have done in recent years.
I do not want to indulge in too much self-flagellation. None of the G7 countries has reached the target, and West Germany and Japan are at about the same stage as us, while—disgracefully—the United States is well below that level. The Scandinavian countries, however, have demonstrated that they have the political will to achieve the target, and I think that we should do the same.
Secondly, I do not consider it right to raid ODA funds to deal with exceptional contingencies. At the end of her speech, the Minister read out some words that were intended to mollify us, to the effect that, if need be, she would always be willing to go back to the Treasury. That, however, does not answer the point made in 1985 by the Select Committee on Foreign Affairs, which stated that exceptional tragedies should not be a charge on the ODA budget. I am sorry to bring up this subject again, but I object in principle to the fact that the Ministry of Defence should be able to say, "Yes, we will help, but the ODA must pay for the petrol."
When we mentioned that last week, the Minister said that we did not understand Government accounting systems. I can only say that, if the Ministry of Defence has to raid the ODA budget to meet some of its costs, those Government accounting systems are wrong in principle. The Treasury should be charged for any extra funds that are needed to deal with such disasters; the ODA budget, limited as it is, should not be expected to contribute to the MoD's costs.
My third point, which appears in the Liberal Democrats' amendment to the motion, relates to the need to establish a more effective rapid-response agency at an international level. I welcomed what the Minister told us about her Department's efforts to establish a register of volunteers; nevertheless, the United Nations Disaster Relief Organisation—apart from being small, as the Minister said—has not the equipment, the staff, the knowledge or the know-how to act quickly.
I am not certain that we have learnt enough from the way in which past disasters have been tackled. I read a report by one of our chief fire officers—I think that it was the chief fire officer in Kent—who had helped to deal with the Armenian earthquake. He made a number of useful points about the need to assemble lists not only of volunteers—the Minister mentioned that—but of agencies, experts, items of equipment, available stocks, tents and supplies of food and water around the globe. That should be done at international level. It is not necessarily a question of stockpiling at great expense in different parts of the world; it is a question of knowing where to go as soon as equipment is required, and of having the machinery to do that immediately.
At present. both the ODA and the United Nations Disaster Relief Organisation respond only to requests made by Governments. During the early stages of the Bangladesh disaster, we were constantly told about the difficulties in communications, and it was said that we were awaiting requests. I do not believe that it is necessary to wait for requests before assembling equipment that will obviously be required.
I followed with great interest what was said by the right hon. Member for Bethnal Green and Stepney (Mr. Shore). In the case of Bangladesh, the great embankments that were funded by the World bank seem to have proved less effective than the more limited local facilities that the people would have wanted. There is, I think, a lesson to be learned: when cash is given, it should perhaps be used to finance less prestigious projects that would have a more direct impact on the people involved.

Mr. Michael Lord: I agree with the right hon. Gentleman that there is little point in setting up massive stockpiles that could cost money, when we do not know whether we shall be dealing with a land or a sea disaster, or whether the temperature will be freezing or very hot. He also said, however, that we should have responded to the Bangladesh disaster before we had been told what was needed. Had we done so, we might well have sent lots of inflatable boats, and it turned out that there were a good many there already.

Sir David Steel: What was manifestly not there—and everyone knew it—was a supply of helicopters. As the right hon. Member for Bethnal Green and Stepney observed, our response in that regard was both slow and inadequate.
In Bangladesh, an immediate injection of cash would have been enormously helpful. Local supplies were available within the country and in neighbouring countries—which, again, was fairly obvious. I am not being pernickety; I am simply saying that, in this age of satellite television, it cannot be right to take the attitude that we should sit around waiting for formal requests from Governments. A more rapid response is required.
Fourthly, in discussing disasters of this kind, we must not lose sight of the long-term programmes with which the ODA and other bodies are concerned. As one who knows Africa better than some of the other areas that we are discussing, I find it deeply depressing that, in the horn, Ethiopia, Sudan and Somalia, famines are recurring that would have been at least partly avoidable if the countries concerned were not wracked by civil wars and maintained by shipments from all the world's arms producers—no doubt including this country in some cases. Another problem is our failure to achieve the standards of irrigation, well-boring and education that are required, on a long-term basis, if we are to prevent the return of famine whenever adverse weather conditions arise. When responding to immediate crises, we must not neglect the long-term needs of that area in particular.
While I am on the subject of the Sudan, let me tell the Minister that my hon. Friend the Member for Liverpool, Mossley Hill (Mr. Alton), who intervened on her speech, has passed me a fax from Christian Aid. It says that the rations for displaced people near Juba have had to be cut because of transport difficulties. The Minister responded earlier on that; will she now back up the request for extra transport funds that has been made both to the European Community and to her own disaster unit?
My final point is this. It is essential that we consider the disasters in waiting. I refer particularly to the advent of cholera in Peru, where I understand some 2,000 people have already died. Some 2 million may die by the end of the year if the international community does not respond. Sudden, unexpected cyclones are not the only causes of disaster. It is also taking our eye off the ball, being occupied with today's disaster so that we neglect disasters that are in the making.
We have just had a report from Frank Judd in Mozambique—whose appointment to the upper House I warmly welcome; as director of Oxfam, he will bring great experience in this field—and he has warned of coming disaster in Mozambique.
I have also had other reports—from Sierra Leone, for example—where there is a threat that the country may follow the path of Liberia if we are not careful. I hope that this will not happen. What worries me is that here is a former British colony and yet it is the American Government and the Nigerian Government that have given substantial help to the Government of Sierra Leone. I understand—I am open to correction if the Minister wishes—that all we have done is send one military adviser. I believe that we have a particular moral obligation to help a country for which we have been responsible.
As another example, there is the situation, already referred to, in Angola, where, thank goodness, there is at long last to be a peace settlement. But what do we discover? It is not a country in which we have a particular interest—it was, of course, a Portuguese possession—but the French have moved in; theirs has become the second language, and they are the people most interested in developing fishery protection and tackling the long-term development needs.
It is rather sad if we are losing our influence in Africa. We are failing to look after not only the interests of the people of Africa but also after British interests in extending commerce and trade.
I said that I would be brief. I have made five general suggestions. If the Government were to pass on three out of the five tonight, I should be extremely happy.

Sir Timothy Raison: I listened to the right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) with interest, and he made a number of valid points, although I would quarrel with one or two of them. The right hon. Gentleman has a slightly false picture of our Government approaching the Government of Bangladesh about what help we can give. We do not sit idle and do nothing until a plea is made to us. If the practice is the same as it always was, and I am sure it is, we would certainly very rapidly have established communication with the Government of Bangladesh, but we would want to be sure of two things: first, that whatever we gave was needed and, secondly, that there was respect for the fundamental principle that, in aid programmes of any kind, we ask the Government concerned what they want rather than simply go in, override them and tell them what they will get. I am sure that that is an absolutely sound principle.
I also believe that the right hon. Gentleman ought to think a little more carefully about the extent of our aid programme. He has said that we should cover all the former British colonies; and goodness knows there are many of them, and many of them are facing very great difficulties. On top of that, he says, we should have major interests in former Portuguese colonies and in south America. But one of the troubles with our aid programme is that it is far too thinly spread; we cover far too many countries already. Rather than look for new areas in which to provide help, we should concentrate harder on providing more help in depth in those areas that we know really well and where we have really strong obligations and historical connections.
However, I do not want to carp at the general tenor of what the right hon. Gentleman had to say. I am sure that the whole House agrees that the extent of the crises in these three areas results in the bleakest picture that any of us who have followed this area over the years have ever known. The sheer awfulness of what has happened almost defies words. That is true, above all, in Africa. I believe that it is there that the gravest situations of all are to be found.
Apart from the intrinsic horror of what is happening, there is a feeling of lost confidence in the aid process, a feeling that aid cannot tackle these things. I do not think that the problem is one of compassion fatigue, although there may be signs of that here and there. I think that there is a kind of despair about what can be done to put these matters right or to prevent these crises.
The despair is triggered off by the fact that so many of the great disasters of the world are caused not just by natural events but by deep political difficulties. It is this that is making it so hard to tackle the things that have to be tackled. It is these political problems, as we see in the middle east and in Africa, that it seems to be beyond the scope of the aid community to solve. There is no need for me to list them, but they include the Kurdish problem, the Ethiopian problem, Somalia, Sudan, Liberia, Malawi, Mozambique, and so on. They are all suffering from profound political problems, which are causing the troubles they have to face.
The question is, what can we do about it? I have to say frankly that the simple remedy of doubling the aid programme will not solve these problems. I believe, indeed, that it would be very difficult to absorb a rapid

doubling of the aid programme, certainly in terms of finding worthwhile projects. That is one of the strange things about this field—that, although the needs are so great, it is very difficult to find worthwhile projects to carry out.
It is fair to make the point that Bangladesh, of all countries, has received enormous quantities of aid in the post-war years. It has been one of the foremost recipients of aid, not only from the United Kingdom, although we have provided a lot, but from many other areas. Bangladesh still faces enormous problems, which have culminated in the recent tragedy. Sudan too has been a very substantial aid recipient until recently, when it became virtually impossible to provide it with aid because of the present hazards in that country.
We have to recognise that, as the critics of aid have pointed out, aid has often been used to prop up incompetent or corrupt regimes. It has not been able to achieve its objectives precisely for that reason. We also have to recognise that aid can even sustain a civil war rather than bring peace. There is a kind of minimum level of activity which is sutained by aid coming into a country, and this can occasionally stop people getting to grips with their problems and allow civil war to continue. Arguably, perhaps, that has been true of Ethiopia, and it is possible that it might happen in Iraq.

Mrs. Maria Fyfe: I wonder whether the right hon. Gentleman will consider rather more carefully the tenor of his remarks in the past few minutes, because they not only encourage the Government to turn away from increasing the amount of aid given but discourage individuals who are giving generously to various aid programmes in Britain from feeling that they should continue. His remarks might encourage people to believe that there is no point in giving any money to anybody.

Sir Timothy Raison: I quite understand why the hon. Lady has said that, but I have constructed my speech to point out what I believe to be very genuine difficulties. I do not think that any of the things that I have said is untrue, and I can assure her that I have thought about them a great deal. But there are also some positive things that I want to say, so perhaps she will listen to them and recognise them.
The fundamental question which I think this debate has exposed is whether we need a change of strategy. In this respect, the speech of my right hon. Friend the Minister was very interesting, and it is worth while considering what she was telling us. Perhaps the point that came over is that we have to think about the role of relief in the aid process as a whole. When I was Minister for Overseas Development, it was felt that relief was a kind of unpleasant necessity that was occasionally pushed on us, and that the whole thrust of ODA and development was long-term development. That was what the money was collected for, and the relief activities were something that had to be dealt with on the side.
Of course, the logic of that is absolutely impeccable. Nobody can deny that, if long-term development can be carried out, there is a chance of averting the disasters that lead to the clamour for short-term relief. That philosophy was absolutely right.
However, what we have to think about now—this is partly what my right hon. Friend was talking about—is whether, in our aid strategy, in planning the organisation of ODA and the way the budget is allocated and so on, we should not recognise that disasters play a bigger part than any of us had expected, and that there must be some change in the strategy and the way in which the Department is organised to have regard to that. That is one of the crucial questions that has cropped up today.
In a way, the wheel has gone full circle. I can take the example of Oxfam. When Oxfam began, it was the Oxford Committee for Famine Relief, set up for the specific purpose of dealing with disasters. Over the years, Oxfam tried to move away from that concept and towards a very strong emphasis on long-term development; as I say, I think that the Government moved in parallel with it. But, like the Government, Oxfam has been forced back on to disaster relief. Since that is so, and since these ghastly disasters do happen whatever we might wish, my right hon. Friend is right to say that we must look at our capacity for dealing with these things.
It may also be said that, although disaster relief is not what we want to be about—it is a cruel necessity—in some ways it is an easier operation to run than long-term development. The record of a lot of long-term development which has been carried out with good intentions by dedicated and skilled people has, nevertheless, been deeply disappointing. The change has not been brought about in the third world that one might have expected from the quantity of resources that have gone into it. That is because the development process is itself a difficult one, and is complicated by political factors.
At least when one is dealing with disaster and famine relief, clear targets can be established. People know what they are trying to do and what they have to deliver and where, and they can get on with the job in a dynamic way. The ODA's record in that area has been excellent. The handling by the disaster unit has always been of high quality.
It may well be that my right hon. Friend is right—I suspect she is—when she says that perhaps we have to enlarge that side. It has already been enlarged, but perhaps that part of the operation has to be increased. It is quite on the cards that there needs to be a shift in the balance within the aid programme from the longer-term work towards the shorter-term work. I think that that applies also to other organisations around the world which are working in that area.
That means that we must carefully examine our ability to cope with disasters. In a way, we have made quite a good job of it. Sometimes, we have been late in the field, but overall our record has been good. But all of us, including the United Nations agencies, the EC and so on, need to do a lot of rethinking.
The response of the EC seems not to have been discreditable. I am glad that, just a few days ago, it made the decision to dispatch, I think, an extra 500,000 tonnes of food aid. That is welcome and has not received enough publicity, but we must look at the mechanisms for delivering disaster relief.
However—here I come back to what I have already said—that does not mean that development ceases to be a vital part of what we have to do. We can see in parts of the world, particularly in Asia, that great gains have been

achieved by development. Many of the Asian economies, in contradistinction to the African economies, are getting on the move.
India, the vastest of all the aid recipients, is showing signs of strength which has gradually been built up. In particular, there are certain forms of aid where one can feel confident of the value of what is being done. I am a firm believer in educational aid and training aid, bringing people here for training or sending our people out to the receiving country. The record of the ODA and the British Council in that area has been good.
Evidently, population aid has to be of great importance. After all, it is the characteristic of the sub-Saharan countries that they have often 3 or even 4 per cent. population increase rates. Above all, there has been great value in the emphasis of the past five or six years on supporting those countries which are prepared to take sensible economic strategies on board and which really have been prepared to take part in a policy dialogue to see that the old ways are not good enough.
The long-term development work is vital. We are in some ways getting a clearer idea of how to bring that about effectively, certainly in the basic economic field. Our great needs are to press on doing all that we possibly can to deal with the political and military obstacles to development which are causing so much cruelty and grief. One profoundly hopes that the talks that are going on about the horn of Africa will lead to success. One profoundly hopes that, in Iraq, we shall not find ourselves with a prolonged civil war breaking out.
All I can say is that I believe that, in tabling their motion this evening, the Opposition have to a great extent missed the point. I do not think that their intentions are wrong, although no doubt they are pretty political, but we must look afresh at all our approaches to this difficult and important area.

Mr. Tom Clarke: There has been an air of unreality about this debate. Apart from my right hon. Friend the Member for Bethnal Green and Stepney (Mr. Shore) and my hon. Friend the Member for Cynon Valley (Mrs. Clwyd), the House has not addressed itself to the enormous problem that exists out there—or perhaps not so much "out there", as modern technology means that our people can see what is going on, and I do not believe that they will feel that we have had the kind of considered and urgent response to the problems of the third world that they are seeing in their living rooms night after night.
The simple truth is that Bangladesh is being struck by a cyclone of indifference every day of its life—as are Africa, Asia and Latin America. We have not begun to address the real problems that exist there in the way that those problems invite.
I do not wish to be uncivil to the Minister of Overseas Development, as she may well be fighting the Treasury in the way that her predecessor attempted to do—we shall try to give her some encouragement today—but would it not have been more honest for the Prime Minister and his various Ministers to acknowledge that, due to the recession which they have largely been responsible for creating, what we have been doing has been woefully inadequate, given the problems of the third world? In no way have we even begun to address the real problems of


long-term development which are so crucial if the problems are to be met. It is not enough to mount fire brigade operations when our consciences are pricked and to ignore what is going on for most of the time.
The right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel), the former leader of the Liberal party, might think that I am being deliberately provocative when I say in the second aid debate that we have had this year that I am almost beginning to despair of the views that he is now expressing. When he calls for a consensus on these vital matters, does he really think that we should pretend that we have views that we do not have? Does he really think that there is a consensus even between the hon. and learned Member for Perth and Kinross (Sir N. Fairbairn) and the Minister?
Tonight, the Minister has expressed views which are a complete repudiation of the speech that the hon. and learned Member for Perth and Kinross gave to the Tory conference at Perth this week. I cannot believe that even the hon. and learned Gentleman, for whom some of us have a sneaking personal respect, would abandon common humanity to enjoy a few transient moments of tabloid fame.

Sir David Steel: I hope that the hon. Member is not going to drag me into this private fight. The consensus that I was seeking was on achieving the UN aid programme, and I know that he will agree with me about that.

Mr. Clarke: I am glad that the right hon. Gentleman made that clear, and that I gave him the opportunity. In his speech he appeared to be asking for a consensus on wider issues and it has to be said that that consensus simply does not exist. It does not befit an Opposition to pretend that it does, in view of the fact that the problems that we are witnessing are not being tackled with the urgency that we believe is vital.
The hon. and learned Member for Perth and Kinross did a great disservice to many people in his constituency, including elderly ladies who work for Oxfam, Christian Aid and the rest, and who ought not to be convinced that their efforts are in vain. I therefore regret his speech, but the House cannot ignore what he said because the real influence upon the Government's shameful policies in these matters may well be reflected in the sort of views that he expressed.

Sir Nicholas Fairbairn: Will the hon. Gentleman tell me what views I expressed?

Mr. Clarke: Because time is limited—

Sir Nicholas Fairbairn: He does not know.

Mr. Clarke: It is not for me to remind the hon. and learned Gentleman of the speech that he made—from time to time, his recollection may be somewhat faded—but if he has any doubts, I refer him to the House of Commons Library and to last Friday's Daily Record. Then he might see the comments that he made, although I do not wish to dwell upon them because they are unrepresentative of the humanity that I believe the people of Scotland feel. Nevertheless, the hon. and learned Gentleman might have done a service to this debate. He has influenced people to believe that the Government are not giving the leadership that we so urgently require.
Frankly, it is not good enough for the Minister for Overseas Development or her colleagues in government to call for leadership within the United Nations when they are not giving leadership here in the United Kingdom.

Mrs. Chalker: What utter nonsense.

Mr. Clarke: Despite her sedentary interruptions, the right hon. Lady has totally failed to explain why the Government have failed to honour their commitment to the target of 0·7 per cent. of gross national product. I am willing to give way to allow her the opportunity to tell us whether that is the Government's commitment. Do they still believe in it? On Thursday, the Prime Minister, no less, told the House:
We have a better record than almost anyone in the world and we can justly be proud of that record."—[Official Report, 9 May 1991; Vol. 190 c. 822.]
The Prime Minister must know that that is absolute nonsense and is not justified by any facts. The Prime Minister need not go any further than our own Library to check facts.
What do we find when we check on our commitment to 0·7 per cent. GNP? Far from the Prime Minister being right in saying that we lead the world, we find that we are behind Denmark, which has achieved 0·94 per cent, France with 0·78 per cent., the Netherlands with 0·94 per cent., Norway with 1·04 per cent. and Sweden with 0·97 per cent. We are even behind countries which have not achieved the figure but are nevertheless doing better than we are—countries such as Australia, Belgium, Canada, Italy, Germany and Japan.
The Government are not doing any service to the people of Britain or to the problems by pretending that they are doing better than they are. If the Government have financial and fiscal problems, they ought to tell us that that is the real reason. They should not try to make a virtue of lethargy, but that seems to me to be the case. The problems that we are debating simply will not go away if that is the Government's approach. Apart from the three areas of crisis that the House has debated today, we have witnessed a decade of economic disaster for sub-Saharan Africa, an extremely unhappy decade for the debt-ridden countries of Latin America. Yet we have also witnessed the fact that the political will on our part to deal with those problems and to offer real leadership to other nations within the UN does not seem to exist. We are therefore entitled to call for a Government who will give these issues real focus and leadership.

Mr. Lord: rose—

Mr. Clarke: I shall not give way. There are many more arguments that Opposition Members would like to make. It would be fine to continue the debate about taxation. The Minister seemed to give the impression that she would even prefer a cut in taxation to an increase in the Government's contribution to overseas aid. Perhaps she should make her position clear in her reply. It is not enough for supporters of the Government, including the Prime Minister, to pretend that we are doing superbly when manifestly that is not the case, and when a Back Bencher, the hon. and learned Member for Perth and Kinross, gives a whole conference the impression that he thinks that we are doing too much and, sadly, gets applause for his views. It is profoundly obscene for us to


witness poverty, deprivation, squalor and death in the third world without feeling angry. As the debate continues, I hope that that anger will be articulated and will intensify.

Several Hon. Members: rose—

Mr. Deputy Speaker: Order. The Front Bench spokesmen wish to reply to the debate at 20 minutes to 10. If hon. Members on both sides are very brief, it should be possible to call most, if not all, of them.

Sir Nicholas Fairbairn: The words of the hon. Member for Monklands, West (Mr. Clarke) were clearly prepared to distort and disguise the important matters which I raised in Perth last week. There is no difference between myself and my right hon. Friend the Minister. The only difference is that last week she spoke second and I spoke first, whereas this evening she spoke first and I am speaking second.
During the time that the hon. Gentleman spoke, the population of the earth increased by five times the entire population of the city of Perth. Such a city is not built in two minutes, every two minutes. If we are talking about disasters, there may be disasters of cyclone or war, but the disaster which happens every day, every hour and every minute is the desperate increase in the population of the world. That is what creates the other disasters.
I am ashamed that the hon. Gentleman, having read a totally misinformed report in the Daily Record, using words which I did not use, should suggest that I am impiteous when a disaster occurs. If a person falls, or if a tragedy occurs, whether in Bangladesh, Somalia or anywhere else, it is natural for all of us to help. May I say to the hon. Gentleman, to the House and, I hope, to a listening world, that it is even more impiteous that we do nothing about the disaster of the increase of the world population, whom we cannot feed or educate and who are the result of unintended pregnancies.
I set up birth control agencies in Edinburgh because in my private practice I saw the tragedy of unintended pregnancy. The world is a tragedy of unintended pregnancy. The people who were washed away in the ghastliness of the Bangladesh cyclone were replaced last week. The population is on the increase again. What is the hon. Member for Monklands, West going to do about that? What will he do about the fact that the populations of Somalia and Ethiopia—thanks to Band Aid, or no thanks to Band Aid—are increasing on an exponential curve? What will the hon. Gentleman do about that? What is his lot going to do about it? What is Geldof going to do about it?

Mr. Tom Clarke: rose—

Sir Nicholas Fairbairn: I will not give way.
What will the hon. Gentleman do? The answer is nothing, except express distress and complain that the Government are not doing enough. Then he will wait for the next plane or overloaded train in Somalia or Bangladesh, or wherever, to crash, and he will say again that the Government are not doing enough. In my opinion, my right hon. Friend the Minister for Overseas Development is one of the most responsible members of the Government. The way in which she has addressed such

disasters as we are discussing has been extremely responsible, and the Government's response has been quite excellent in scale and direction.

Mr. Foulkes: Will the hon. and learned Gentleman give way?

Mr. Fairbairn: No. The hon. Gentleman cannot just wander round to the Front Bench for the purpose of getting me to give way. Someone wrote to me saying, "I wish his father had used a condom." But I did not use the word "condom" in my speech.
The Government have been very responsible in the face of these disasters, but the great disaster that faces us all is the fact that the population of the earth is expanding out of control. Other disasters will occur increasingly until we address that basic fact. It is a matter to which we should be giving much more attention. I shall say so again and again, however much it offends Opposition Members, until we address the distress of unintended pregnancies in the first, second or third world, or any other world. That will be the answer to the tragedy of mankind. What is now the cause of that tragedy will continue to be the cause. There is no point in asking the Government occasionally to send a fire engine if the children are not prevented from playing with fire.

Mr. John McFall: This motion is about famine, flood and disaster. The concern of the hon. and learned Member for Perth and Kinross (Sir N. Fairbairn) may be gauged from the fact that he made no mention of the people who are currently suffering. That is what we are interested in today. My hon. Friend the Member for Cynon Valley (Mrs. Clwyd) has said that poverty and conflict are at the root of the problems. Indeed they are.
Before the Gulf war began, I said that winning the peace would be harder than winning the war. Consider the billions upon billions of pounds that were spent on winning that war. We spent at least £2,000 milllion in the United Kingdom. What have we spent on winning the peace? We have spent £21 million on aid for the Iraqi Kurdish refugees and given £12 million to the EC. We are one of the smallest contributors in the entire EC. The Minister is shaking her head. Even if the figure were doubled, it would not compare with the amount of money that was spent instantly for the purpose of winning the war. One is forced to deduce that the Government are concerned less about winning the peace than they were about winning the war.
What is happening today? Arms sales are progressing apace. Every Thursday, the Joint Intelligence Committee of the Cabinet considers, among other things, the arms sales. But those sales continue. This week, the New York Times said that President Bush is strangely silent about the need to curb the sale of conventional arms to the middle east. The new weapons sent to the middle east by the United States in this year alone are worth over $33 billion. Eight of the 15 former top importing third-world countries are in the middle east. Another disaster, another Saddam, and we will have our eyes shut. Where is the new world order we were talking about? Was it merely the United Nations with a respray, which is now showing the old rust? We need not so much a new world order as a new economic order. That is the root of the problem.
We went to the Gulf to defend our interests. As a tragic Kurdish refugee said in the mountains, "The Kuwaitis had oil and they were saved; the Kurds had no oil, so we were annihilated." If we say that we care about human beings—whether Kurds, Iraqis or Bangladeshis—we should treat them all the same, but we have not done so. The conclusions from the Gulf war are that it was a war about resources. We shall face the same problem time and time again, if we continue to keep our eyes shut, as we have done until now.
What about Iraq? We have heard nothing about the Shi'ites and we should be doing even more for the Kurds. But what about the innocent Iraqi people whose infrastructure was demolished in Iraq? We have not heard about them. We were told about smart bombs in Iraq—the reality behind smart bombs is that they bomb now and kill later. Every day, innocent Iraqi people are suffering from bad health and from lack of water and electricity resources because we have bombed their country. We have destroyed their infrastructure and we are not lifting a finger to help them.
I mentioned poverty. In the 1960s, President Reagan said, they fought a war against poverty and lost. I believe that it is individuals such as President Reagan and our former Prime Minister, the right hon. Member for Finchley (Mrs. Thatcher) who have put us in our current position. They had a blinkered vision of the third world and they believed that the market would solve the problems. We know that the market does not solve them in developed countries, let alone in the third world.
It is no accident that the world now faces a litany of disasters. All over the world, the seeds of poverty are bearing a bitter harvest. I ask the Minister for Overseas Development, what will she do about that?
A month or so ago, I read in The Daily Telegraph about Bill Deedes, a high Tory by any measure. He went to the Sudan and, in moving words, he said that the animals die first, the children die next and then the adults take their turn to die. Twenty-seven million people are today facing that reality. During the Gulf war, we made that point to the Government, but the Press Gallery was empty so there was little response in the newspapers the next day. Twenty-seven million people are dying. What is happening in Africa today? Incomes are falling by 25 per cent., commodity prices have fallen by 30 per cent., per capita spending on health is down by 50 per cent. and spending on education is down by 25 per cent.
The right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) mentioned Peru, which is undergoing a cholera epidemic. That epidemic could be prevented if money was used not to service debts, but to help the people. It is an obscenity that every United Kingdom citizen pays, if I remember correctly, more than £6 a week to the banks for third-world debts, to help commercial interests such as NatWest and other groups that recklessly granted loans in the 1970s. Every individual has to pay the price today, while the banks are let off. That is an obscenity, given the fact that millions and millions of people are suffering in the world.
I want a Government commitment that at the Group of Seven meeting in July they will declare an assault on poverty. The World bank has already said that a concerted effort will take 400 million people out of poverty by the

year 2000. The Archbishop of Canterbury says that the first priority in his reign will be an attack on poverty. I want the Minister to convey that to the Prime Minister, and put the rhetoric into action.
An international disaster relief agency is essential. There are, I know, plans for that at the moment. In addition, however, we need a humanitarian support operation. We face today the cocktail of mass hunger. That is the recipe that lies ahead of us. The shades of 1974—the last food disaster—are with us.
The point of tonight's debate is that the key to the problem is famine prevention. Until that issue transcends political differences, we shall get nowhere. Development is the best antidote to famine. The Government have made no commitment to that. Their record is abysmal. Given that their record is so abysmal, all that we can do is to vote against their amendment.

Mr. Michael Lord: It is interesting to follow the hon. Member for Dumbarton (Mr. McFall). He told us about all the problems that face the world, many of which we would all agree about, but then he went on to blame the Government for most of them, or for not doing all that they should. That is the wrong impression to give. I believe that our Government have done as much as they possibly could in the circumstances.
I therefore congratulate my right hon. Friend the Minister for Overseas Development on her caring, purposeful and, I believer, practical approach to the problems that we face. I, as much as anybody, would like the United Nations target to be reached. I am sure that my right hon. Friend agrees with me about that and that she will do all that she can to enable that target to be reached as soon as possible.
Aid is always a highly emotional matter. In a way, that is no bad thing. Emotion can be the driving force for action. In that sense, it can help. Emotion, however, is no substitute for practical help, either in emergencies or in the longer term. Enormous amounts of money are constantly being poured into the third world—and rightly so—by Governments, voluntary organisations and other organisations such as Band Aid, to which reference has already been made. Furthermore, there have been the efforts of people such as Bob Geldof, but still we see the pitiful sights on our television screens, and people are asked to give more and more.
Why are such huge amounts of money still needed with such sad regularity? There are two basic reasons—first, the forces of nature, and secondly, the internal structures of the countries concerned. We can do nothing about natural forces—cyclones, hurricanes, tornadoes, drought and so on. We may hate to admit it when we can put men on the moon and fly around the world in a matter of hours, but the truth is that some forces are still greater than man can cope with, and always will be.
To counteract the worst effects of disasters and to make peaceful progress within third-world countries, it is essential to have internal structures which will allow that to happen. Sometimes as a country we are made to feel very guilty about the problems in Africa. When colonial powers were involved in that continent there were no wars. People lived in peace. When colonial powers were in Africa, it was self-sufficient. People were not hungry.

Mr. Jeremy Corbyn: Thousands were killed in colonial wars.

Mr. Lord: Now, Africa takes two thirds of the world's aid; then, it was self-sufficient. I do not want to turn the clock back to those days, but I do not believe that we as a nation should feel guilty about the fact that then Africa was self-sufficient, whereas now it takes such a huge amount of the world's aid. More importantly, it suggests that, in order to combat famine and disease and to cope when disaster strikes, we must have peace, stability and a workable infrastructure of some sort.
What can we do? How can we help? We can certainly give aid in the short term. We can also involve ourselves in long-term aid. We are doing that. We know, however, that the problems will return unless some fundamental changes are made to the way that many third-world countries run their affairs. Many hon. Members referred to the same point. Most of them were on this side of the House, but the right hon. Member for Bethnal Green and Stepney (Mr. Shore) mentioned it, too. We respect the sovereignty of all nations. We are told that we cannot interfere in the internal affairs of other countries. That being so, how can we help if rulers will not let us help, and if corruption is rife? How can we help when a civil war is in progress? It cannot be done.
The hon. Member for Cynon Valley (Mrs. Clwyd) said that Africa needed a famine early warning system. food stores and a proper transport system. She suggested that others, perhaps the United Nations, should be undertaking such work. I agree that those tasks should be undertaken, but if we are not careful, by doing them we shall take over the running of the countries concerned, which we are not allowed to do.
While we cannot run the affairs of other countries, respecting their sovereignty often happens at the expense of the people of those countries. A way must be found to make the United Nations more dynamic. At the time of the Gulf war, even when we anticipated that it would be a horrific problem, we hoped that out of it would come a United Nations with more moral strength and determination, perhaps being willing to intervene on occasions when in the past it has not felt strong enough to do so. I urge my right hon. Friend to press her Government and United Nations colleagues to try to achieve intervention when that is in the best interests of the nations that we are trying to help, for without co-operation no amount of aid will help.
The basis difference between the two sides of the House is that Opposition Members seem to believe that by throwing money at the problems that we are debating, they will be solved. My hon. Friends and I disagree with that philosophy. I agree that more aid should be given, but until that aid is accompanied by co-operation from the countries that we are trying to help, disasters will continue to recur and, sadly, we shall have debates of this kind for many years to come.

Mrs. Maria Fyfe: It was clear during the speech of the hon. and learned Member for Perth and Kinross (Sir N. Fairbairn) that the Minister was becoming more and more embarrassed by his remarks, but Government policy is in reality much closer to the views of that hon. and learned Gentleman than one might think.
Consider, for example the position of Kurdish refugees in Britain today, of whom there are about 800. The British

Government have the nerve to take to task the perfomance of the nations surrounding Iraq in endeavouring to cope with over 2 million refugees, when we in Britain spend money not on trying to help Kurdish refugees—to permit them to have political asylum and stay here—but on sending them back to face whatever horrors may be inflicted on them. The Home Office sought and obtained an extra £12 million from the Treasury to achieve a faster turnround of people who face death on their return to Iraq.
The Minister said that war was part of the problem, and that is true. Why then do the Government permit the Birmingham arms fair to go ahead? Why are they not taking a closer look at the affairs of countries to which Britain sells arms? We should be making greater efforts on that front.
The Minister said that giving 0·7 per cent. of our GNP in aid would not be achievable unless the economy improved. But 0·7 per cent. is a proportion, not a sum of money. We want that proportion to be achieved regardless of the performance of the economy. As the economy improves under a Labour Government, 0·7 per cent. will be a vastly increased sum going to world aid.
The hon. Member for Suffolk, Central (Mr. Lord) talked a lot of nonsense about the good old days of imperialism, when there were no wars and the countries now needing aid were self-sufficient. Has he never heard the expression "economic imperialism"? One does not have to be in full control of countries to dictate what goes on in them.
As I have time to take only one example, I shall cite that of Sierra Leone, which used to be fully self-sufficient in growing rice for its people and preserving their lives. That country cannot be held responsible for the fact that Liberia's civil war is spilling over into Sierra Leone. We have a treaty with Sierra Leone, but it is receiving no aid. In the meantime, far from growing its own rice, it must import every grain from the United States and pay massive debts to the International Monetary Fund and bankers. It is suffering from having built up massive debts and interest rates.
Countries such as Sierra Leone, Nicaragua, El Salvador and many others whose populations are in desperate poverty are compelled by rich western countries to run their economies in a way that does not help their people but simply provides more profit for the rich countries of the world. The Government must face up to that real issue, which a Labour Government will address, and talk about solving it. To talk about contraception in that context is obscene nonsense.

Mr. Alistair Burt: The House can always tell when an hon. Member gets uncomfortably close to the truth, especially if he or she expresses views that contain a grain of truth. People laugh nervously and then scatter and hide behind the parapets.
I should like to read the following passage:
The population problem in Bangladesh is awesome. The problem of people has been defined: too many, too close, too young and too late … there are too many women starting child-bearing too early, before they are fully grown. They are under-nourished and have too many babies too close together, which not only undermines their own health, but also that of their babies. Fifty per cent. of babies born in Bangladesh are below normal birth weight and almost all mothers are anaemic. More than ninety per cent. are born at


home, and the majority delivered by untrained attendants; resulting frequently in tetanus for mother or child, which is almost invariably fatal. This is part of the vicious cycle faced by females, starting when they are born, that has to be broken.
Those are not the words of my hon. Friend the Member for Perth and Kinross (Sir N. Fairbairn) or a statement from the Government. They come from Fiona Duby, who is a health worker on an NGO project in Bangladesh, and they appeared in the British Overseas Aid 1990 annual review.
We may not like the way our colleagues sometimes express things that happen to be true, but on over-population, but we laugh at them at our peril.

Mr. Jeremy Corbyn: This debate could not be more timely. The most appalling disasters have occurred in Bangladesh, Kurdistan and Africa. There is no shortage of popular support for getting aid and help to those disaster areas.
However, I deplore the way in which journalists keep writing about donor and aid fatigue, because it is very damaging to non-governmental organisations that are doing their best to get aid quickly to those who need it most. Journalists could do more useful work by writing about the background to those disasters rather than speculating about donor fatigue.
The case of the Kurdish people has been raised in the House many times. Indeed, I have been highlighting their plight for many years. Clearly, they have the most desperate short-term needs for medicine, blankets, food and engineering help, just to survive. As we speak, children are dying on the mountains, and many people are dying of starvation in that region.
Unless a long-term political solution is found to the aspirations of the Kurdish people, the problem will return time and again. Sadam Hussein has always done deals with the Kurdish people when he is weak and has killed them when he is strong, as he did in 1988 at Halabja.
Emergency aid is desperately needed. The British Government could find more than £1 billion to fight the Gulf war, without any vote in the House to support their decision, so I find their niggles about small sums of money in an aid budget quite distasteful. If we were serious about conquering hunger, the world arms bill alone could do so. The question is whether there is the political will to do so.
The 1980 World bank report stated:
present output of grain alone could supply every man, woman and child with more than 3,000 calories and 65 grammes of protein per day. Eliminating malnutrition would require redirecting only about 2 per cent. of the world's grain output.
Those figures were relevant in 1980. Obviously, the exact figures have changed now, but clearly the world would be capable of feeding itself if wealth were properly distributed throughout the world. A recent World Food Programme report showed that 29 million people in 25 countries—mainly in Africa—were at risk of immediate death from starvation. Against that background, we must consider the economic relationship.
Some 100,000 people in Bangladesh have died as a result of the recent cyclone, and 10 million people are homeless. Polluted drinking water and various other problems will hit that country very quickly. Those

problems will not go away and must be faced in the spirit that we live in one world and one planet. At present, instead of vast amounts of aid flowing from the richest to the poorest countries, the wealth flows the other way, as it has for every one of the past 200 years. The debt crisis affecting third-world countries at present means that, in real terms, they are subsidising the banking systems and commodity brokers of the north, at the expense of their own people. The closure of hospitals and health services in Mexico, Peru, Bolivia and other countries, insisted on by the World bank and the International Monetary Fund, is a major part of the problem.
We have a role to play in providing rapid emergency aid, and we must do so. We also have a role to play in providing programme aid to ensure that there is consistent, long-term economic and agricultural development in those countries. We also have a responsibility to ensure that the debt problems of third-world countries are solved. Those problems are best met by writing off debts, which prove an unbearable burden for those countries. We must also insist and ensure that the real prices of the commodities produced by third-world countries increase. In a basket of commodity prices, most countries now receive less in real terms than they did in 1950—more than 40 years ago.
Unless we address these problems, the basically economically based disasters—albeit some of them are environmentally based—will return to haunt us again and again. We must do something to write off the debts and restore a balance in the world's wealth, to ensure that the real wealth created goes to those who most desperately need it, not to finance the profligate consumption of the super-rich of western Europe and north America.

Mr. Harry Barnes: I have time to raise just one item—British aid to the Kurds.
The generosity of the British people in assisting the Kurds has been considerable. It was reflected in the events of this weekend, but that was by no means the extent of the generosity, because we are now seven weeks into the problem faced by the Kurds.
As soon as the pictures came on to our television screens, people up and down this country got together in communities and villages and started to collect blankets, groundsheets, tents and the necessary supplies to be sent out to the Kurds. By 4 April, a group called British Aid for the Kurds had been established—a successor organisation to that which sent parcels to the British troops during the Gulf war. That was a straightforward exercise, because there were plenty of MOD aeroplanes flying to the Gulf, so supplies could be sent.
But there have been massive logistical problems in getting British aid to the Kurds. The ODA has not been able to respond to the work that has been done as it could have had the resources been available. That has nothing to do with shortcomings on the part of the people in the disaster unit, who have worked admirably in difficult circumstances. The problem is the vast shortfall in the resources provided for the ODA to handle crises.
There is a big unwritten story that the media have not got hold of—about how people responded as soon as the crisis was known, and how it has taken so long to get the goods out to Turkey, and especially to Iran. We have often had to depend on Iran Air to fly the goods out, and until


recently it has had to pay landing charges at Heathrow. Indeed, I understand that Iran Air still has to pay landing charges if the flight is considered scheduled.
The case of British aid for the Kurds reveals the inadequacy of the ODA, and its inability to handle three massive crises at one time. Its procedure for handling what we may call normal passing disasters is to send two 707s with medical and other supplies and to buy goods in local markets to provide assistance in an area. That procedure is not capable of beginning to touch the problems in Bangladesh and the horn of Africa, or the problems of the Kurds. In short, the Government need to adjust their operations.

Mr. George Foulkes: I am pleased that all the Members who wanted to contribute to this important debate have been able to do so—albeit rather briefly in the case of the last few speakers.
The hon. Member for Bury, North (Mr. Burt) asked us to bear in mind the important issue raised in a rather eccentric fashion by the hon. Member for Tayside, North. Hon. Members on both sides of the House are not unaware of the problems associated with population and development. There is an active all-party group on population and development chaired by the hon. Member for Devizes (Sir C. Morrison). I have not seen the hon. Member for Tayside, North attending its regular meetings.

Sir Nicholas Fairbairn: On a point of order, Mr. Speaker. I am not the Member for Tayside, North. I represent Perth and Kinross.

Mr. Foulkes: I must apologise profoundly to the hon. Member for Tayside, North (Mr. Walker). I never thought that I would be able to insult him.
It is an unusual pleasure to be able to start by welcoming some of what the Minister has said. I welcome first what I interpret as the announcement of the establishment of a mobile emergency volunteer force with doctors, engineers and other experts available to be mobilised and sent immediately to help when disasters happen.
Secondly, I welcome the expansion of the disaster unit. A few weeks ago it consisted of only four people. After our private notice question on 3 May, the number rose to six. After the statement demanded by the Opposition on 8 May, there were nine people, and today it has been announced that the number is now 12. After a few more private notice questions and statements, and a few more debates initiated by the Opposition, perhaps we shall get a disaster unit big enough to cope with the scale of these disasters. The people in that unit do not stand idly by when there are no disasters—planning is an essential element in coping with disasters, and the unit will be planning for potential disasters of all kinds.
Much of what the Government have done over the past few months has been in response to pressure from the public, the media and, if I may say so, from the Opposition. I shall not disappoint the Minister by congratulating her on everything, however, for there is much more to be done. I intend to repeat some of the unanswered questions and deal with some of the Government's misinformation.
The aid budget is inadequate. It has been squeezed again and again as existing allocations have been used to

help cope with disasters. We are only one and a half months into the financial year and already about three quarters of the contingency fund has been used. It is fairly certain that in the next 10 and a half months there will be more disasters to cope with. There are major demands on the programme from other parts of the world, and parts of the programme will inevitably be harmed if more and more is taken out of an already small budget to help in disaster areas.
The budget is already 11 per cent. down in real terms. The Prime Minister said that this country is generous, and the Minister for Overseas Development implied that the budget is increasing. That is untrue. The Minister's answers to questions from my hon. Friend the Member for Cynon Valley (Mrs. Clwyd) show that the aid budget is on the way down. Trying to meet extra needs and demands from a shrinking budget clearly places great strain on other aspects of the aid budget.
My hon. Friend the Member for Cynon Valley and the right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) asked the Minister about extra funds. My hon. Friend quoted from The Guardian, and the Minister has said several times that she would be prepared to ask for more money. In a debate earlier this month I tried, as always, to be helpful. In reply the Minister said:
I believe that more resources are necessary in these exceptional circumstances, but, however helpful he might think his comments are, the hon. Gentleman must leave to me the approaches that I have made, and continue to make, for the resources that I need to carry out my job efficiently."—[Official Report, 8 May 1991; Vol. 190, c. 741.]
In her winding-up speech, will the Minister state clearly the results of her approaches? How much new money—not money from the contingency fund or from the overstretched aid budget—is there for the Kurds, for Bangladesh and for famine in Africa? We have tried to get a straight answer but we have not received one. We want a straight answer now.
Ministry of Defence charges were raised by hon. Members on 3 May, 8 May and in this debate. If the reason is not cost, why are the Government reluctant to mobilise the forces of the Ministry of Defence? Those forces have the experience and the will to carry out the task, and they have the equipment and personnel. Field Marshal Lord Bramall has said that they are ideally equipped for that task, but the Minister says that the ODA has to pay the extra costs.
The hon. Member for Beckenham (Sir P. Goodhart) quoted Hugh Hanning of the Fontwell group. Mr. Hanning has conducted much work on the matter. He has produced a pamphlet and written many articles and, as the hon. Member for Beckenham said, he clearly understands the issue. Hugh Hanning said that the United Kingdom is the only country whose Ministry of Defence does not deduct training costs from the charges that are made. Will the Minister make that absolutely clear, and will she approach the Ministry of Defence and the Treasury to make sure that the extra burden of training costs does not fall on the already overstretched ODA budget?
I am afraid that the Minister's strategy has be be described as diversionary tactics. One of my hon. Friends referred to it as scapegoatism. The Minister blamed the delay in mobilising forces and assistance in Bangladesh on the weather. One of my hon. Friends tried to intervene to suggest that the right hon. Lady might have been on holiday at the time and that that might have delayed the response. In the context of the famine in Africa, the right


hon. Lady attacked bureaucracy in the European Community and the following week she had to apoligise to the Community because she was wrong.
Now the Minister is attacking the United Nations. She is saying, "It is not the fault of the British Government; responsibility lies with the United Nations." All the United Nations agencies are having to work with both hands tied behind their backs because of the collapse of the funding and assistance made available by the Government to the United Nations.
Several hon. Members, and especially the right hon. Member for Aylesbury (Sir. T. Raison), spoke about the despair that is felt in tackling some of the problems, given their magnitude. He was a Minister for Overseas Development, and he has discussed these issues before. Indeed, he has raised them again and again.
Most of the despair in most of the countries where there are disasters arises from the huge debt burden that most of them have to bear. There is not, as some Conservative Members fondly imagine, a huge transfer of resources from the rich countries to the poor. Given the payment of interest charges and the repayment of debt, there is a net transfer from the poor countries to the rich, despite all the aid that we give. There must be major debt forgiveness. Help must be given to the countries that are so poor.
We have a moral responsibility, and humanity should motivate us in this place as it motivates the British people outside. The British people are generous with their voluntary donations and the Government must match that generosity. The British people want a swift response, and the Government must give it. We want to see a response out of common hunanity, but we also want to see political stability and economic prosperity in the countries where disasters have struck. In that way, we shall have security and safety in working with countries that we know to be politically stable and economically prosperous. It is in our interests to help them, as well as in the interests of the poor and of the peoples who are threatened with debt in so many countries around the world.

Mrs. Chalker: We have had a good debate. It has been rumbustious at times, but it has revealed yet again the concern and anxiety that is felt on both sides of the House in response to a great issue. Our anxiety is fully shared by the British people. That was shown by the magnificent response on Sunday to the Simple Truth concert.
I shall try to respond to some of the comments that have been made in the debate, but before doing so I say that, as politicians, we must respond constructively and practically when dealing with the public purse. That response has been forthcoming, and in recent months £70 million has been provided for the Iraqis and £90 million for Africa. A starting sum for Bangladesh—I have always made it clear that it was for immediate relief—is the £6·5 million that has been announced so far.
There have been some interesting contributions to the debate. For the first time in history, I found myself agreeing with the hon. Member for Islington, North (Mr. Corbyn). I agreed with what he said about journalists reporting the debate, and with his remarks about the need to resolve the situation of the Kurdish people.
I do not always quote The Guardian, but this evening I shall quote from the "Notebook" column:
The British government's leadership in each of the current international relief operations—for the Kurds, Bangladesh and Africa—is indisputable. It has moved quickly, efficiently and generously to deliver the right kind of assistance to those who most need it in meaningful amounts.
If the Opposition do not believe what they read in The Guardian today, I shall. Many fair-minded people share the view expressed in the column to which I have referred. That is why I have consistently paid tribute to my staff, to non-governmental organisations and to all others who have helped. Such remarks, however, will not discourage us from considering urgently what further improvements can be made to the way that we and the international community distribute aid.

Mr. Campbell-Savours: Will the right hon. Lady give way?

Mrs. Chalker: No, I shall not give way to the hon. Gentleman. I have only seven minutes to complete my speech before the House divides.

Mr. Campbell-Savours: The Minister has still not answered my question.

Mrs. Chalker: I shall answer the hon. Gentleman if he will stop making a noise. I shall tell him where I was.

Mr. Campbell-Savours: Answer the question!

Mrs. Chalker: I shall tell the hon. Gentleman where I was, if he will listen. On 27 March, I was in my office. On 28 March through to 4 April. I was ill, unfortunately. I kept in touch with my office by telephone and fax machine throughout that time. If the hon. Member for Workington (Mr. Campbell-Savours) has not suffered the pain of a gallstone, he does not know what it is.
I referred earlier to our review. UN co-ordination is needed urgently. I was not criticising individual agencies, as the hon. Member for Cynon Valley (Mrs. Clwyd) seemed to think: I was expressing my regret—I know that my view is shared by many other member countries—that, despite the excellent efforts of people "on the ground", we were not able to secure co-ordination with those at the top to bring together the available resources quickly. We are now working to solve that problem, as we have been doing for some time. It was last September, when I went to Jordan, that I realised that it was a problem. The review that we have set in train—which deals with how we should handle major disasters simultaneously—is going well, and I hope that before long I shall be able to inform the House of the outcome.
I have taken note of the many comments that have been made tonight by hon. Members on both sides of the House. I do not agree with my right hon. Friend the Member for Aylesbury (Sir T. Raison) that there has been a loss of confidence in the aid process as such; the current frustration is, I think, caused by the size of the problems that are developing, and the frequent inability of receiving Governments to work with donor Governments to resolve those problems. Things have improved in many of the countries concerned, for the simple reason that many more countries are now working away at the process of economic reform. It is interesting to note how much better they have done in terms of growth—as shown by the World bank's long-term report—when they have undertaken economic reform programmes.
I understand the deep concern about debt. Let me point out, however, that it was the present Prime Minister who took the lead as Chancellor, building on the debt cancellation initiative of my right hon. Friend the Member for Blaby (Mr. Lawson) in 1987. That is how we worked out the Trinidad terms. My right hon. Friend the Prime Minister set out those terms imaginatively and generously. They called for the cancellation of two thirds of eligible official bilateral debt, and for the repayment of the balance over 25 years. The Trinidad terms are a British initiative, which has been welcomed by donors and debtors alike. Our aim is for them to be accepted by the G7 summit that will be held in London in July, and we are working towards that.
The question of money is important. The hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes), alas, was not listening to what I said so carefully in my opening speech, because he was talking to his hon. Friend the Member for Cynon Valley. I said that the Government would continue to look sympathetically at the resources available to the ODA, so that Britain could continue to play its full part in the international relief effort to help alleviate the terrible suffering in Africa, and to assist the people of Bangladesh to reconstruct their lives.
There is no dispute about the fact that the aid budget was cut nearly a decade ago as part of the process of getting total public expenditure under control. It has, however, increased in real terms in the past three years. New money has been made available: that is my straight answer. Already this year, £30 million from the Treasury has been added to the aid budget.
Let me also say to the hon. Gentleman—as I have said before—that I am engaged in discussions. I am not in a position to give him answers and, in any event, those answers must be answers to the very necessary case that we make. I believe, however, that MOD costs are entirely proper. My understanding with my right hon. Friend the Secretary of State for Defence about the training value of the relief operations will be taken into account in the amount charged to the ODA.
I commend the Government's amendment, and ask the House to reject the Opposition motion.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 188, Noes 292.

Division No. 143]
[9.59 pm


AYES


Abbott, Ms Diane
Boateng, Paul


Adams, Mrs Irene (Paisley, N.)
Boyes, Roland


Allen, Graham
Bray, Dr Jeremy


Alton, David
Brown, Gordon (D'mline E)


Archer, Rt Hon Peter
Brown, Nicholas (Newcastle E)


Armstrong, Hilary
Brown, Ron (Edinburgh Leith)


Ashdown, Rt Hon Paddy
Buckley, George J.


Ashley, Rt Hon Jack
Caborn, Richard


Ashton, Joe
Callaghan, Jim


Banks, Tony (Newham NW)
Campbell, Menzies (Fife NE)


Barnes, Harry (Derbyshire NE)
Campbell, Ron (Blyth Valley)


Barnes, Mrs Rosie (Greenwich)
Campbell-Savours, D. N.


Barron, Kevin
Carlile, Alex (Mont'g)


Battle, John
Carr, Michael


Beckett, Margaret
Cartwright, John


Beith, A. J.
Clark, Dr David (S Shields)


Bell, Stuart
Clarke, Tom (Monklands W)


Benn, Rt Hon Tony
Clwyd, Mrs Ann


Bennett, A. F. (D'nt'n &amp; R'dish)
Cohen, Harry


Bermingham, Gerald
Cook, Robin (Livingston)


Blair, Tony
Corbett, Robin


Blunkett, David
Corbyn, Jeremy





Cousins, Jim
McKelvey, William


Cryer, Bob
McLeish, Henry


Cummings, John
McMaster, Gordon


Cunliffe, Lawrence
McNamara, Kevin


Dalyell, Tam
McWilliam, John


Darling, Alistair
Madden, Max


Davies, Rt Hon Denzil (Llanelli)
Mahon, Mrs Alice


Davis, Terry (B'ham Hodge H'l)
Marek, Dr John


Dewar, Donald
Marshall, David (Shettleston)


Dixon, Don
Martin, Michael J. (Springburn)


Dobson, Frank
Martlew, Eric


Doran, Frank
Maxton, John


Duffy, A. E. P.
Meacher, Michael


Dunnachie, Jimmy
Michie, Bill (Sheffield Heeley)


Dunwoody, Hon Mrs Gwyneth
Michie, Mrs Ray (Arg'l &amp; Bute)


Eadie, Alexander
Morley, Elliot


Eastham, Ken
Morris, Rt Hon A. (W'shawe)


Ewing, Mrs Margaret (Moray)
Morris, Rt Hon J. (Aberavon)


Fatchett, Derek
Mowlam, Marjorie


Fearn, Ronald
Mullin, Chris


Flannery, Martin
Nellist, Dave


Flynn, Paul
Oakes, Rt Hon Gordon


Foot, Rt Hon Michael
O'Brien, William


Foster, Derek
Patchett, Terry


Foulkes, George
Pendry, Tom


Fraser, John
Pike, Peter L.


Fyfe, Maria
Powell, Ray (Ogmore)


Galbraith, Sam
Prescott, John


Galloway, George
Primarolo, Dawn


Garrett, John (Norwich South)
Radice, Giles


Garrett, Ted (Wallsend)
Randall, Stuart


George, Bruce
Redmond, Martin


Gilbert, Rt Hon Dr John
Rees, Rt Hon Merlyn


Godman, Dr Norman A.
Reid, Dr John


Golding, Mrs Llin
Richardson, Jo


Gordon, Mildred
Robertson, George


Gould, Bryan
Robinson, Geoffrey


Graham, Thomas
Rogers, Allan


Griffiths, Nigel (Edinburgh S)
Rooker, Jeff


Griffiths, Win (Bridgend)
Rooney, Terence


Grocott, Bruce
Ross, Ernie (Dundee W)


Hardy, Peter
Ruddock, Joan


Harman, Ms Harriet
Salmond, Alex


Haynes, Frank
Sheerman, Barry


Heal, Mrs Sylvia
Sheldon, Rt Hon Robert


Henderson, Doug
Shore, Rt Hon Peter


Hinchliffe, David
Short, Clare


Hogg, N. (C'nauld &amp; Kilsyth)
Sillars, Jim


Home Robertson, John
Skinner, Dennis


Hood, Jimmy
Smith, Andrew (Oxford E)


Howell, Rt Hon D. (S'heath)
Smith, C. (Isl'ton &amp; F'bury)


Howells, Geraint
Smith, Rt Hon J. (Monk'ds E)


Howells, Dr. Kim (Pontypridd)
Soley, Clive


Hughes, Robert (Aberdeen N)
Spearing, Nigel


Hughes, Simon (Southwark)
Steel, Rt Hon Sir David


Illsley, Eric
Steinberg, Gerry


Ingram, Adam
Straw, Jack


Janner, Greville
Taylor, Mrs Ann (Dewsbury)


Jones, Ieuan (Ynys Môn)
Taylor, Matthew (Truro)


Kaufman, Rt Hon Gerald
Thompson, Jack (Wansbeck)


Kennedy, Charles
Vaz, Keith


Kinnock, Rt Hon Neil
Walley, Joan


Kirkwood, Archy
Wardell, Gareth (Gower)


Lamond, James
Welsh, Andrew (Angus E)


Leighton, Ron
Wigley, Dafydd


Lestor, Joan (Eccles)
Wilson, Brian


Lewis, Terry
Winnick, David


Livingstone, Ken
Wise, Mrs Audrey


Lofthouse, Geoffrey
Worthington, Tony


Loyden, Eddie
Wray, Jimmy


McAllion, John



McCartney, Ian
Tellers for the Ayes:


Macdonald, Calum A.
Mr. Thomas McAvoy and Mr. Allen McKay.


McFall, John





NOES


Adley, Robert
Amess, David


Aitken, Jonathan
Amos, Alan


Alexander, Richard
Arbuthnot, James


Amery, Rt Hon Julian
Arnold, Jacques (Gravesham)






Aspinwall, Jack
Franks, Cecil


Atkins, Robert
Freeman, Roger


Baker, Rt Hon K. (Mole Valley)
French, Douglas


Baker, Nicholas (Dorset N)
Fry, Peter


Baldry, Tony
Gardiner, Sir George


Batiste, Spencer
Gill, Christopher


Beaumont-Dark, Anthony
Gilmour, Rt Hon Sir Ian


Bendall, Vivian
Glyn, Dr Sir Alan


Bennett, Nicholas (Pembroke)
Goodhart, Sir Philip


Benyon, W.
Goodlad, Alastair


Bevan, David Gilroy
Goodson-Wickes, Dr Charles


Biffen, Rt Hon John
Gorman, Mrs Teresa


Blackburn, Dr John G.
Gorst, John


Blaker, Rt Hon Sir Peter
Grant, Sir Anthony (CambsSW)


Body, Sir Richard
Greenway, Harry (Ealing N)


Bonsor, Sir Nicholas
Gregory, Conal


Boscawen, Hon Robert
Griffiths, Sir Eldon (Bury St E')


Boswell, Tim
Griffiths, Peter (Portsmouth N)


Bottomley, Peter
Ground, Patrick


Bottomley, Mrs Virginia
Grylls, Michael


Bowden, A. (Brighton K'pto'n)
Hague, William


Bowden, Gerald (Dulwich)
Hamilton, Hon Archie (Epsom)


Bowis, John
Hamilton, Neil (Tatton)


Boyson, Rt Hon Dr Sir Rhodes
Hannam, John


Brandon-Bravo, Martin
Hargreaves, A. (B'ham H'll Gr')


Brazier, Julian
Hargreaves, Ken (Hyndburn)


Bright, Graham
Harris, David


Brown, Michael (Brigg &amp; Cl't's)
Haselhurst, Alan


Browne, John (Winchester)
Hawkins, Christopher


Buchanan-Smith, Rt Hon Alick
Hayes, Jerry


Buck, Sir Antony
Hayhoe, Rt Hon Sir Barney


Budgen, Nicholas
Hayward, Robert


Burns, Simon
Heath, Rt Hon Edward


Burt, Alistair
Heathcoat-Amory, David


Butler, Chris
Hicks, Mrs Maureen (Wolv' NE)


Butterfill, John
Hicks, Robert (Cornwall SE)


Carlisle, Kenneth (Lincoln)
Higgins, Rt Hon Terence L.


Carrington, Matthew
Hind, Kenneth


Carttiss, Michael
Hogg, Hon Douglas (Gr'th'm)


Cash, William
Holt, Richard


Chalker, Rt Hon Mrs Lynda
Howarth, Alan (Strat'd-on-A)


Channon, Rt Hon Paul
Howarth, G. (Cannock &amp; B'wd)


Chapman, Sydney
Howell, Rt Hon David (G'dford)


Chope, Christopher
Howell, Ralph (North Norfolk)


Churchill, Mr
Hughes, Robert G. (Harrow W)


Clark, Dr Michael (Rochford)
Hunt, Sir John (Ravensbourne)


Clark, Rt Hon Sir William
Hunter, Andrew


Colvin, Michael
Irvine, Michael


Conway, Derek
Irving, Sir Charles


Coombs, Anthony (Wyre F'rest)
Jack, Michael


Coombs, Simon (Swindon)
Janman, Tim


Couchman, James
Johnson Smith, Sir Geoffrey


Cran, James
Jones, Robert B (Herts W)


Currie, Mrs Edwina
Kellett-Bowman, Dame Elaine


Curry, David
Key, Robert


Davies, Q. (Stamf'd &amp; Spald'g)
King, Roger (B'ham N'thfield)


Davis, David (Boothferry)
Kirkhope, Timothy


Day, Stephen
Knapman, Roger


Devlin, Tim
Knight, Greg (Derby North)


Dickens, Geoffrey
Knight, Dame Jill (Edgbaston)


Dicks, Terry
Knowles, Michael


Dorrell, Stephen
Knox, David


Douglas-Hamilton, Lord James
Lang, Rt Hon Ian


Dover, Den
Latham, Michael


Dunn, Bob
Lee, John (Pendle)


Durant, Sir Anthony
Leigh, Edward (Gainsbor'gh)


Dykes, Hugh
Lennox-Boyd, Hon Mark


Eggar, Tim
Lilley, Rt Hon Peter


Emery, Sir Peter
Lloyd, Sir Ian (Havant)


Evans, David (Welwyn Hatf'd)
Lloyd, Peter (Fareham)


Evennett, David
Lord, Michael


Fairbairn, Sir Nicholas
Luce, Rt Hon Sir Richard


Fallon, Michael
Lyell, Rt Hon Sir Nicholas


Favell, Tony
McCrindle, Sir Robert


Field, Barry (Isle of Wight)
Macfarlane, Sir Neil


Fishburn, John Dudley
MacGregor, Rt Hon John


Forman, Nigel
Maclean, David


Forsyth, Michael (Stirling)
McLoughlin, Patrick


Forth, Eric
McNair-Wilson, Sir Michael


Fox, Sir Marcus
McNair-Wilson, Sir Patrick





Madel, David
Shephard, Mrs G. (Norfolk SW)


Major, Rt Hon John
Shepherd, Richard (Aldridge)


Malins, Humfrey
Shersby, Michael


Mans, Keith
Sims, Roger


Maples, John
Skeet, Sir Trevor


Marland, Paul
Smith, Tim (Beaconsfield)


Marlow, Tony
Speed, Keith


Marshall, Sir Michael (Arundel)
Speller, Tony


Martin, David (Portsmouth S)
Spicer, Michael (S Worcs)


Mates, Michael
Squire, Robin


Maude, Hon Francis
Stanbrook, Ivor


Mayhew, Rt Hon Sir Patrick
Stanley, Rt Hon Sir John


Mellor, Rt Hon David
Steen, Anthony


Meyer, Sir Anthony
Stern, Michael


Miller, Sir Hal
Stevens, Lewis


Mills, Iain
Stewart, Allan (Eastwood)


Mitchell, Andrew (Gedling)
Stewart, Andy (Sherwood)


Mitchell, Sir David
Stewart, Rt Hon Ian (Herts N)


Moate, Roger
Sumberg, David


Monro, Sir Hector
Summerson, Hugo


Montgomery, Sir Fergus
Tapsell, Sir Peter


Moore, Rt Hon John
Taylor, Ian (Esher)


Morris, M (N'hampton S)
Taylor, Teddy (S'end E)


Morrison, Sir Charles
Tebbit, Rt Hon Norman


Moss, Malcolm
Temple-Morris, Peter


Moynihan, Hon Colin
Thompson, D. (Calder Valley)


Neale, Sir Gerrard
Thompson, Patrick (Norwich N)


Nelson, Anthony
Thornton, Malcolm


Neubert, Sir Michael
Thurnham, Peter


Nicholls, Patrick
Townend, John (Bridlington)


Nicholson, David (Taunton)
Townsend, Cyril D. (B'heath)


Nicholson, Emma (Devon West)
Tracey, Richard


Norris, Steve
Tredinnick, David


Onslow, Rt Hon Cranley
Trippier, David


Oppenheim, Phillip
Trotter, Neville


Page, Richard
Twinn, Dr Ian


Paice, James
Vaughan, Sir Gerard


Patnick, Irvine
Viggers, Peter


Patten, Rt Hon John
Wakeham, Rt Hon John


Pattie, Rt Hon Sir Geoffrey
Walden, George


Pawsey, James
Walker, Bill (T'side North)


Peacock, Mrs Elizabeth
Walker, Rt Hon P. (W'cester)


Porter, David (Waveney)
Waller, Gary


Powell, William (Corby)
Walters, Sir Dennis


Price, Sir David
Ward, John


Raffan, Keith
Wardle, Charles (Bexhill)


Raison, Rt Hon Sir Timothy
Watts, John


Rathbone, Tim
Wells, Bowen


Redwood, John
Whitney, Ray


Rhodes James, Robert
Widdecombe, Ann


Riddick, Graham
Wiggin, Jerry


Ridley, Rt Hon Nicholas
Wilkinson, John


Ridsdale, Sir Julian
Wilshire, David


Roberts, Sir Wyn (Conwy)
Winterton, Mrs Ann


Roe, Mrs Marion
Winterton, Nicholas


Rossi, Sir Hugh
Wolfson, Mark


Rost, Peter
Wood, Timothy


Rumbold, Rt Hon Mrs Angela
Yeo, Tim


Sayeed, Jonathan
Young, Sir George (Acton)


Scott, Rt Hon Nicholas



Shaw, David (Dover)
Tellers for the Noes:


Shaw, Sir Giles (Pudsey)
Mr. David Lightbown and Mr. John M. Taylor.


Shaw, Sir Michael (Scarb')



Shelton, Sir William

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

MR. SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved,
That this House welcomes the Government's swift and continuing generous responses to the crises in Iraq, Bangladesh and Sub-Saharan Africa; and also welcomes the Government's initiatives to ensure the continuing effectiveness of United Kingdom aid and to stimulate improved international disaster relief delivery.

PETITION

Wolverhampton Group of Steel Companies

Mr. Donald Thompson: With your permission, Mr. Speaker, I bring a petition on behalf of Simon Fletcher who is petitioning this House because he believes that there have been grievous miscarriages of justice with regard to various companies, principally the Wolverhampton group of steel companies, for a long number of years.
Wherefore your petitioner prays that your Honourable House may be pleased to Order a Bill of Review of the matters set forth or to Order such other enquiry or course as to your Honourable House may seem fit in order to examine and evaluate the said miscarriage and to give relief to all other the Companies named together with their bona fide Creditors and/or Contributories in the said Liquidations and the right of the last named to the enjoyment of free association by restoration of such Companies to the Register (due allowance being made in cases of the Wolverhampton Group of Steel Companies for the properly ascertained Compensation payable and allowable to each in its own right pursuant to the two several Nationalisations of the Steel Industry which have occurred and of whose benefits (they) have been denied less such sums as were realised and properly applied in each several Liquidation on fair and level terms as is and has been given to all other Her Majesty's Subjects.
And your petitioner as in duty bound, will ever Pray, &amp;c.

To lie upon the Table.

Oil Fires (Kuwait)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Nicholas Baker.]

Mr. Tam Dalyell: Richard North commenced his striking Sunday Times colour supplement report:
Man's assault on the air he breathes was never so blatant, wilful or ugly, as it is in the oil fields of Kuwait. Up to 5 million barrels a day of excellent light crude, among the easiest to refine in the world, is burning filthily—enough to match Britain's daily consumption every eight hours.
The Secretary of State, whose presence I very much welcome as a courtesy, will recognise from his recent visit the description by one of my service constituents that the midday sun was like the midnight moon.
That leads me to the first of a number of questions of which I have given notice to the Minister. The first is to ask for an objective report from Sir Donald Acheson, the chief medical officer, on his view of the dangers of hydrogen sulphide and the number of parts per million which could cause serious respiratory disease. When sheep have been slaughtered and their lungs examined, black spots have been found on the lungs. Are black spots also, one wonders, found on the lungs of human beings?
My greatest concern, after talking to world authorities in Edinburgh, Cambridge and Oxford whose names are known to the Minister, is about polycyclic aromatic hydrocarbons. I do not think that there would be much dispute that polycyclic aromatic hydrocarbons are carcinogenic—they cause cancer. If, as we are told, these have been identified, I hope that the Department of Health report will give its view. I hope that it will also say what happens when temperatures go up to 120 deg F. concentrating the smoke into a thicker, low-lying cap over the desert sands.
Perhaps the problem can be encapsulated in the sad and ironic tale of the 17 scientists who were going round Kuwait with their clipboards, asking residents about their symptoms, about the water they drank and about the silent killer, water-borne disease. They found at the end of the first day that the forms were splattered with oil and, in a sense, the medium was the message.
Normally I do not submit to the House anonymous letters, but I know that this is genuine:
I wrote to you a few days ago regarding our troops in Ahmadi and Kuwait City.
The news continues to make very grim reading. Day becomes night—sitting with only the light from candles in oil-smoke filled corridors. What is achieved other than a deterioration in health?
Letters are taking up to 22 days to reach home. THREE WEEKS is a dreadful length of time to wait for news.
They are our forgotten Army—no proper back-up now; after all, the War is over, isn't it?
Someone must do something about getting our Service Personnel out of that Hell hole before permanent damage is done to their health. They would be better employed in northern Iraq.
I am sorry not to be able to give my name but you are not supposed to interfere when your loved one is serving in the Forces.
I welcome the presence of the Minister of State for the Armed Forces. I hope that inquiries will be made of our servicemen as to what they are now going through.
Secondly, I refer to the Secretary of State's helpful letter of 7 May, in which he outlines the need for massive logistical support. Who will organise this massive logistical


support? It is not my business to try to abuse the Kuwaitis, who have been through terrible things. But is it not the case that Kuwait is paralysed and cannot undertake this task? As the fires rage, the situation gets worse. I ask specifically why for so long, it was left to Bechtel and, for example, Robbie Middleton, who accompanied the Secretary of State on a journey that I am told by several people was very successful. I have to be candid and say that I gather that the Secretary of State led that mission very satisfactorily. On that score, there is no criticism at all from me, but I must ask why the matter was left to the Americans for so long.
Where will the transport come from? Where will the water supplies come from? Where will the specialised equipment come from? What attention is being paid to the inventions of people like Professor Harper of Heriot-Watt, whose case I brought to the attention of the Department? I hope that the Minister will say something about what "help" and "encouragement"—to use words in the letter of the Secretary of State—can be given to the Kuwaiti British Fire Group.
Thirdly, in the presence of the Minister of State for the Armed Forces—indeed, in the presence of any Minister—I should say that I quite sure that the service men who have to deal with the mines and the unexploded shells have a most thankless and dangerous task. Of course, the booby traps have to be removed. I should like to pay tribute to the two Financial Times journalists who lost their lives in the course of their reporting duty. The Financial Times has reported these events with great distinction. The truth is that in that area one cannot walk off tarmacadam—indeed, even off fresh tyre tracks. We should all like to see detectors of non-metallic mines invented.
I want to ask about tunnelling, about the construction of culverts. Is the operation still short of bulldozers? In a written reply of 13 May, the Minister of State said:
Face masks are available to these personnel and they are advised to avoid strenuous activity when in areas suffering heavy air pollution.
Are face masks available to people other than key personnel? My understanding is that more ought to be available.
I want to ask also about world weather, about the climatic effect. Areas from Turkey to China are affected. What is the Government's view on what Dr. Houghton and Dr. Browning, those distinguished scientists of the Meteorological Office, are now saying? I do not think that I break Chatham house rules—the gentleman has said this elsewhere—when I say that Professor Akbar Ahmed, professor of arabic studies at Cambridge, said that his relations in Quetta, in Baluchistan, were now affected by what was happening in Kuwait.
I also ask, is there not a reasonable chain of cause and effect which we should investigate and which may link Kuwaiti oil fires to the cyclone in Bangladesh? That link will be difficult to prove or disprove, but if the Kuwaiti oil fires have caused or are causing the unusual weather in the Bay of Bengal, they must be quenched as soon as possible and for the additional reason of the sake of humanity.
The argument is, briefly, that, due to the rotation of the earth, the general wind pattern is a westerly air stream from Kuwait towards India and Bengal. There is already evidence that the Himalayan snows have been darkened by Kuwaiti oil smoke. About 100 million tonnes of oil a year

is burnt in Kuwait, but it is burnt inefficiently and probably 1 per cent. appears as soot. Kuwaiti crude typically contains 4 per cent. sulphur. The sulphur oxide—SO2—is an absorber of sunlight. It changes to SO3 and then to SO4, which is sulphuric acid. That mechanism is believed to have caused the type of cold that led to the extinction of the dinosaurs.
The concept of a nuclear winter suggests that dust clouds from atomic bombs rising to the upper atmosphere could produce permanent climatic change. The oil fires in Kuwait are producing soot on the scale of an atomic war. Carbon dioxide—CO2—and the direct heat are unlikely to be so important. However, cyclones are instabilities between bodies of air at differing temperatures. Warm air trapped below cold air can rise and rotate to produce high winds, rain and high tides. In Bangladesh, the coastal cyclones are usually most devastating in the autumn, but this is an early cyclone and one has to ask whether it will be followed by others. Those people who opted for war have an obligation to put as much effort into the ecological battle as they did into Desert Storm. It is up to the Government to persuade us that that is being done.
I suppose that it is tempting for people to attribute the unprecedented disaster merely to the wickedness of Saddam Hussein. Neither I nor my hon. Friend the Member for Bolsover (Mr. Skinner), who is present, is under any misapprehension about Saddam Hussein, but we and 32 others thought that the war option was the wrong way to tackle the problem. To prevent the answer that the disaster is merely the fault of Saddam Hussein, I report what I heard at a Kingston Labour party meeting last week. An Iraqi from Basra—a Shia whose family had suffered terribly from the Sunnis—said that if, every day, for 36 days as much explosive as was used on Hiroshima is used against one's country, vengeance and irrationality take over and people detonate oil wells.
The purpose of the debate is to ask the constructive question, "What on earth can be done about it now?"

The Parliamentary Under-Secretary of State for Energy (Mr. Colin Moynihan): I am grateful to the hon. Member for Linlithgow (Mr. Dalyell) for initiating this Adjournment debate. The grim situation in Kuwait has not disappeared from the public mind in Britain or in the rest of the world.
The scale of Saddam Hussein's vandalism is vast. In addition to the oil fires, serious damage has been deliberately targeted at key oil and gas establishments. Saddam Hussein and his destruction squads deliberately set out to destroy the wells and thus delay Kuwait's ability to produce oil and processed products in refineries, at petrochemical plants and power stations. Saddam Hussein ordered the systematic mining and booby-trapping of the surroundings of the blazing oil wells. That ordnance must be cleared before well control work commences. Shifting sands and lakes of oil cover unexploded mines. All this makes it difficult to estimate how long restoration work will take.
In responding to this man-made disaster, the Government are continuing the commitment that they made, with the other allies, to free Kuwait through Operation Desert Storm. The allies responded then to the Kuwaitis' appeal for help against Iraqi aggression. The Gulf oil fires are a deplorable consequence of that


aggression, and the Kuwaitis have again appealed to the international community for assistance. I hope to persuade the hon. Gentleman that the commitment to help Kuwait now is just as strong.
I assure the hon. Gentleman that the Government are offering the Kuwaitis help to tackle the fires and block off the flows of oil. My right hon. Friend the Prime Minister took a strong lead with his early visit to Kuwait soon after the liberation of that country, with direct offers of help to the Crown Prince. This has been followed up with a visit by my right hon. Friend the Foreign Secretary, the Secretary of State for Trade and Industry and the Secretary of State for the Environment, who is currently in Kuwait. My right hon. Friend the Secretary of State for Energy took the latest mission of business men to Kuwait on 26 April 1991 to give United Kingdom proposals his personal backing, and he is confident that British companies will obtain major contracts.
Bringing the fires under control is taking much longer than any of us would like. However, I think that we are all aware that the oil industry has never had to face a disaster on such a scale with, initially, more than 600 burning or leaking oil wells. Many methods have to be used—and, indeed, new ones developed—to bring the tragedy to a close as soon as possible.
The Kuwait authorities, in the first instance, have relied on the historically successful well control companies from North America, such as Red Adair and Boots and Coots, to fight the oil well fires. We can all understand why the Kuwaitis did that. There has been no opportunity to develop a significant UK capability because of the very low number of blow-outs and fires in the UK compared with North America. However, there are so many wild wells in Kuwait that the Kuwaitis have appealed for international help, and British companies have seen an opportunity to develop their technology and experience.
It is in response to that appeal that my right hon. Friend the Secretary of State for Energy led the business mission to Kuwait last month, and I am very pleased to report that British companies are now getting major contracts. Indeed, the Kuwaiti British Fire Group, a consortium including AMEC, Taylor Woodrow and Wimpey, has led the way with an announcement today of receipt of a letter of intent for a major contract to tackle the oil well fires.
The KBFG has to mobilise its team in Kuwait within three days of agreement of the final contract conditions and funding arrangements, and then it has a further 21 days to assess damage to the wells and produce a detailed report to the Kuwait Oil company. It is hoped to begin the practical process of extinguishing fires once its survey and report are complete and agreement has been reached with Kuwait Oil on a plan of action. The survey will give the KBFG the opportunity to examine in detail each individual well and decide upon the best method of extinguishing the fires and controlling the oil flow. In addition to traditional means of well capping and relief well drilling, it is considering a number of innovative alternative techniques, in liaison with Kuwait Oil.
The KBFG will be sending out a field team of 18 to undertake the initial survey work. When the survey is completed it will be in a better position to assess the overall numbers of people required for the oilfield rehabilitation project. In addition to the enormous resource base offered by AMEC, Taylor Woodrow and Wimpey, the KBFG will draw on the resources of other international companies such as BP for technical support, Royal Ordnance for its

skills in dealing with explosives and mine clearance, and others. The KBFG is equally supported by AMEC, Taylor Woodrow and Wimpey with a three-man executive board co-ordinating the project. The project's second phase is expected to be worth many millions of dollars.
The KBFG survey will be based just north of Kuwait, close to the Sabriyah oil field. However, as part of the survey it will assess the most suitable site for a large-scale encampment that best facilitates the oil field rehabilitation programme. This contract is good news all round—good news for the Kuwaitis as they fight to control the fires, good news for the KBFG consortium, and good news for other British companies bidding to offer help to Kuwait. I am sure hon. Members will join me in wishing the Kuwaitis and KBFG every success.
AMEC, one of the KBFG partners, has also been involved with Biwater Ltd. in the refurbishment of the old British Army married quarters at Fahaleel, south of Kuwait City. This base will provide accommodation to attract mainly British firms and their staff. Two hundred beds in single rooms are becoming available at the aptly named BRIT camp—short for British reconstruction implementation team. Both the Ministry of Defence and the Royal Engineers have been involved in making the campsite safe and providing it with transport facilities. Full information on the camp has been sent to 370 companies which have expressed a written interest.
Of course, the KBFG contract comes only a month after Royal Ordnance obtained a major contract from the Kuwait Ministry of Defence for battle area and explosive dump clearance. The contract covers a large proportion of Kuwait, both around population centres and around oil wells. Clearance of the war zones will allow the environmental clean-up to proceed safely. This was "contract No. 1", as the Kuwaitis term it—the first signed with a British company. The KBFG's is the second. The substantial Royal Ordnance contract will go well into 1992. It is another concrete example of the support that British firms are giving to Kuwait, continued today by the KBFG.
Another example of United Kingdom assistance to the Kuwaitis, and one in which, I know, the hon. Member for Linlithgow has taken great interest, is the involvement of the Royal Engineers in dealing with the aftermath of the invasion. The engineers have had no direct involvement in fighting oil fires, but assistance and advice has been provided on the disposal of unexploded ordnance by Royal Engineers personnel in Kuwait. In addition, the Royal Engineers have given safety briefings and have produced maps showing danger areas and leaflets giving safety advice. As the hon. Gentleman knows, the Royal Engineers do not have any equipment specifically designed to extinguish oil fires. Nor are Royal Engineers personnel trained in the very specialised techniques required. However, they have standard equipment—for example, bulldozers, cranes and fork lift trucks—which can be of some use.
Similarly, short-notice but none the less invaluable assistance has been provided in the restoration of power to the Kuwaitis, when a combination of British service men and British Electricity International were involved.
On the question of health, I am well aware that the hon. Gentleman was keen to receive a Government view on the health risks associated with the indigenous Kuwaiti population as well of those expatriates directly involved in trying to extinguish the dreadful oil well fires. On 9 May,


the hon. Gentleman draw that matter to the attention of the Leader of the House and today I have obtained information which I hope will be of assistance to the hon. Gentleman.
I am advised by the Department of Health that close to burning oil wells, high concentrations of toxic irritants, including smoke, carbon monoxide and sulphur dioxide, will be produced. They may present serious problems to those involved in fire fighting operations.
The smoke is likely to be an irritant, although its activity in this regard will depend on its exact composition. Simple masks will reduce the amount of smoke inhaled. Because crude oil is burning, the presence of organic compounds, such as polycyclic aromatic hydrocarbons as the hon. Gentleman said, should be anticipated. However, possible carcinogenic effects would be related to long-term cumulative exposures; short intermittent exposures from the fires would not be expected to add perceptibly to such risks, and would be negligible compared with risks of burns, explosions or traumatic injury while actually fire fighting.
Exposure to carbon monoxide in the smoke plume could lead to fatigue and some impairment of performance of the tasks in hand, but in the open-air conditions of the fires, exposures are unlikely to be sufficient to cause concern.
Whilst I do not have all the details, I am advised that sulphur dioxide is an irritant and in high concentrations may trigger an attack of bronchospasm in asthmatic people. Asthmatic attacks may be precipitated at sulphur dioxide concentration of about 2,500 mcg per cu m. Asthmatics who develop an attack as a result of exposure would require medical treatment. Some non-asthmatics could experience airway irritation and coughing. Peak sulphur dioxide concentrations of 2,700 mcg per cu m have been measured in the plume 100 km downwind from the source. If this information is reliable, concentration closer to the source could be higher than that, and people in that area could be exposed to high concentrations of sulphur dioxide.
Some oil wells which were blown up but not burning were reported to be producing large quantities of hydrogen sulphide. That is a very toxic gas and every effort should be made to eliminate exposure to it. At low concentrations, the characteristic smell of rotten eggs and the accompanying eye irritation will be noticed. Higher concentrations cause loss of the sense of smell and pulmonary damage, and damage to the nervous system may follow rapidly. This problem has been dealt with by setting such remaining wells alight. Although it is highly odorous and has acute toxic properties, hydrogen sulphide has not been reported to have carcinogenic effects.
Further away from the fires, the concentrations of smoke and toxic gases will fall but, as yet, no clear information on actual ground level concentrations has appeared. It seems unlikely from what is known that there will be long-term effects, but in the absence of satisfactory data we cannot be certain of this; nor is it possible, therefore, to make any definitive statement.
Although there have been theoretical levels of ozone and nitrogen dioxide at ground level of the order of 200 to 300 parts per billion measurements in the plume have been substantially lower. Concentrations of below 300 parts per

billion of ozone or nitrogen dioxide do not pose a major danger to health, although some individuals taking exercise out of doors may experience coughing and discomfort on taking deep breath. Effects may be limited by reducing exposure and limiting exercise out of doors.
Experts currently in the area should be well aware of those problems and should have the necessary protective equipment, including closed-circuit breathing apparatus for use if circumstances demand it.
I hope that the hon. Member for Linlithgow will agree that this comprehensive statement will be helpful in responding to him.
The hon. Gentleman also raised the important question of the environmental effects of the Gulf crisis. I know that he and Dr. Nigel Downing, the distinguished maritime biologist, met my hon. Friend the Parliamentary Under-Secretary of State for the Environment to discuss his concerns about the effect of oil spills and the Iraqi occupation of coral islands in the north of the Gulf. My hon. Friend accepted the importance of the islands and summarised the help that the Department of the Environment have been able to offer Dr. Downing, such as assistance with flights and contacts in the Gulf states.
I am aware also that the Kuwaitis are concerned about the threat to animal life from the smoke plume. Both the Saudi National Commission for Wildlife Conservation and Development and our own natural history museum have taken an interest in the environmental problems in Kuwait, in particular the case of the offshore coral islands in the Gulf. I am sure that my hon. Friend will continue to provide Dr. Downing and other environmental authorities with any assistance that his Department can provide.
The hon. Member for Linlithgow mentioned Bechtel, which is a large establishment with a strong commitment to the United Kingdom. It employs 1,200 staff, 600 of whom are employed abroad, and its responsibilities include the middle east. About 100 of its staff were held hostage in Iraq, where it had a contract, after Saddam Hussein invaded Kuwait.
Before the land war started for the liberation of Kuwait, the London office of the Kuwait Oil Company invited Bechtel to provide a back-up service of fire-fighting teams from north America, which were to be employed by KOC directly. Bechtel have, therefore, been responsible for all the support services required, including the provision of water, construction plant, vehicles, accommodation and personnel. After a slow start, which was understandable given the conditions prevailing in the aftermath of war, and the regrettably well targeted Iraqi sabotage, steady progress has been made, with some 90 wells extinguished and capped. Water supplies are now reported to be adequate to support the fire- fighting teams. I understand that Bechtel now has in Kuwait 200 staff controlled from its London office, with a further 100 expected soon.
The Kuwaiti authorities understandably want to extinguish and cap more wells more quickly and have invited groups other than the north American fire fighters to supplement their needs. I am pleased to note that there is British involvement, once again, with the British Kuwait Fire Group offering a turnkey contract. I welcome all efforts from the United Kingdom to assist Kuwait to overcome its problems.
I revert to my earlier comments on our overall reconstruction programme. There is no doubt that our performance has made a good impression on the Kuwaitis.
I shall respond to the meteorological issues raised by the hon. Member for Linlithgow as soon as possible in writing.
This country played a vital role in the liberation of Kuwait from the terror of Saddam Hussein, a terror which has left its environmental scar on that nation. We shall continue to play a leading role in the reconstruction of Kuwait, and can be justly proud of our efforts so far.

Mr. Dalyell: I thank the Minister for that serious answer. He has answered my questions in the spirit in which they were asked last week.
On the issue of the polycyclic aromatic hydrocarbons, is he prepared to give me the evidence of Sir Donald Acheson that short-term exposure may not have deleterious effects? I will not challenge the chief medical officer on his own ground but I should be more than curious to ascertain what evidence the Minister is relying on.

Mr. Moynihan: As the hon. Gentleman knows, not being a Minister in that Department, I went to

considerable lengths to ensure that my Department could deliver as comprehensive a statement as possible today. However, that point will not be lost on the Department of Health. If the hon. Gentleman wishes to put the question to my colleagues in that Department, they will clearly have a responsibility to reply.

Mr. Dalyell: The impression created by the Minister's reply is that there is still a great deal to be done on the provision of some not very sophisticated equipment, and that time may not be on our side. As I understand it, the sheer heat generated makes it more and more difficult, not least with the change in the weather, to tackle the number of oil wells that we should. Is the Minister satisfied that all the equipment, even that which is unsophisticated, is being sent out as soon as it can be?

The motion having been made after Ten o'clock and the debate having continued for half an hour, MR. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at sixteen minutes to Eleven o'clock.